Obesity is a global health crisis affecting developing nations, including India. The management of obesity continues to evolve with newer drugs, metabolic and bariatric surgery and endoscopic interventions, requiring family physicians and specialists to adapt their clinical practice accordingly. There is an urgent need for a standardized algorithm to diagnose, stage, and treat obesity. The Endocrine Society of India (ESI) and the Obesity Surgeons Society of India (OSSI) appointed a steering committee to develop an evidence-based algorithm for managing patients with obesity in India. This was put to vote by 80 specialists (38 from OSSI and 42 from ESI) in a physical meeting. A proposed stage-wise algorithm based on Edmonton Obesity Staging System, Asian definition of obesity, and resources in India, received 100
Klebsiella species are important opportunistic pathogens involved with a remarkably diverse set of community-acquired and healthcare-associated infections. Among these species, K. pneumoniae is the most clinically important, most commonly associated with pneumonia, urinary tract infections, bacteraemia, and liver abscesses. The significant global rise of multidrug-resistant (MDR) strains, such as the extended-spectrum β-lactamase (ESBL) and carbapenemase producers, has severely limited treatment options and has led to Klebsiella pneumoniae as a public health threat. Adding to this threat has been the emergence of hypervirulent lineages capable of causing invasive disease in otherwise healthy individuals, with reports of resistance converging with hypervirulence increasing. Other members of the genus, K. oxytoca and K. variicola, are increasingly noted for their ability to cause disease as well. This review summarizes the recent taxonomic updates, virulence mechanisms, resistance determinants, clinical spectrum and therapeutic options for Klebsiella species, in particular K. pneumoniae, highlighting emerging global and regional trends and the urgent need for new diagnostic, treatment, and prevention strategies in this age of antimicrobial resistance.
BACKGROUND: Gastric perforation is a surgical emergency with evolving etiologies. While traditionally linked to the use of Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) in elderly individuals, a rising incidence in young adults is increasingly associated with polysubstance use. This report compares two distinct cases to highlight the demographic and pathophysiological dichotomy facing surgeons today. CASE REPORT: We present two contrasting cases of gastric perforation. The first is an 85-year-old male with chronic NSAID use who presented with an acute perforation, with histopathology of the ulcer edge unexpectedly revealing high-grade dysplasia. The second case involves a 32-year-old male with a history of polysubstance use, including methamphetamine, who presented with a diagnostically challenging ischemic perforation that required computed tomography for diagnosis following an initially negative upright abdominal radiograph. Both patients were successfully managed with modified Graham patch omentoplasty. DISCUSSION: These cases represent fundamentally different disease processes: one driven by chronic prostaglandin inhibition leading to a premalignant lesion, and the other by acute sympathomimetic-induced vasoconstriction resulting in ischemic necrosis. This comparison underscores two critical lessons: the importance of maintaining a high index of suspicion and the liberal use of cross-sectional imaging in young patients with polysubstance use, and the non-negotiable mandate for routine ulcer edge biopsy in all perforation cases to identify underlying pathology such as dysplasia. Management must extend beyond surgical repair to include oncological surveillance or addiction rehabilitation, tailored to the underlying etiology.
Introduction: Clinical skill training is traditionally imparted through demonstrations, where students directly observe the procedure. However, with increasing student numbers and limited faculty, real-time demonstrations may face issues such as overcrowding, limited opportunities for supervision and inconsistency when taught by different faculty. Instructional videos for clinical skills are now gaining attention as an alternate teaching method. Aim: To compare the effectiveness of instructional video with real-time demonstration, for training in basic clinical skills, among phase I MBBS students, and to analyse the perception of students of the two methods. Materials and Methods: This quasi-experimental study was conducted in the Department of Physiology of Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, India, from February 2025 to July 2025. It included 150 MBBS students of phase I. Six clinical skills in physiology were selected for teaching, which included knee jerk, biceps jerk, plantar reflex, pupillary light reflex, ocular movements and Rinne’s test. Students were divided into three batches of 50 each. Each batch was further divided into two groups of 25 each; one group was trained in a clinical skill by real-time demonstration, whereas the other group was taught using an instructional video, recorded in the department. Following the intervention, the students in both groups were assessed by an Objective Structured Practical Examination (OSPE) by faculty in the department. After three sessions, crossover was done so that all students could be exposed to both teaching methods. The preference of students to both methods was assessed by a 5-item Likert scale. The post-intervention OSPE scores were compared, and statistical analysis was performed using the Mann-Whitney U test. Results: Out of the 150 students included in the study, 108 were females and 42 were males. The participants were aged 18–21 years, with a mean age of 19.2±1.4 years.Students taught via instructional videos showed significantly higher median and mean OSPE scores for plantar reflex {median of 4 (IQR 3-4), mean score of 3.68±1.03, p-value <0.01} and pupillary reflexes {median=4, IQR (3-4.5), mean=3.8±0.91, p-value=0.001}. For the other skills, knee jerk, biceps jerk, ocular movements, and Rinne’s test, although differences were not statistically significant, the instructional video method showed higher central tendency measures. The mean preference score was significantly higher for instructional videos across all five items. Conclusion: Instructional videos were found to be an effective and preferred method for clinical skill training among students in phase I of the MBBS.
Introduction: Coronavirus Disease-2019 (COVID-19) demonstrates marked heterogeneity in clinical outcomes, ranging from mild illness to severe disease and death. Early identification of patients at risk of deterioration is essential for timely intervention. Inflammatory haematological indices such as Neutrophil-Lymphocyte Ratio (NLR) and Platelet-Lymphocyte Ratio (PLR) have emerged as potential prognostic markers, but comparative evidence from Indian tertiary care settings remains limited. Aim: To evaluate and compare the prognostic value of admission-day NLR and PLR for predicting mortality and Intensive Care Unit (ICU) admission among hospitalised COVID-19 patients. Materials and Methods: This retrospective study included 521 Reverse Transcriptase Polymerase Chain Reaction (RT-PCR)-confirmed COVID-19 patients admitted between January and December 2021 in Sree Gokulam Medical College and Research Foundation, Thiruvananthapuram, Kerala, a tertiary care hospital in Southern India. Demographic details, co-morbidities, and baseline haematological parameters were analysed. NLR and PLR were calculated from admission complete blood counts. Receiver Operating Characteristic (ROC) curve analysis, logistic regression, and linear regression models were used to assess prognostic performance. Results: The median NLR was 7.17 (IQR 3.71-11.25), and the median PLR was 200.22 (IQR 128.8-268.4). An NLR cut-off of 4.875 predicted mortality with an AUC of 0.832, sensitivity of 67.1%, and specificity of 83.1% (p-value <0.0001). PLR showed lower discriminative ability (AUC 0.694). Admission-day NLR independently predicted ICU admission (OR 1.257; 95% CI 1.181-1.339). Both NLR and PLR were associated with longer hospital and ICU stay. Conclusion: Admission-day NLR is a superior predictor of mortality, ICU admission and duration of ICU/hospital stay duration compared to PLR. Its low cost, ease of calculation, and strong prognostic value make it a practical tool for early risk stratification.
