Teerthanker Mahaveer Medical College & Research Centre

Background: Septic arthritis is an orthopedic emergency requiring rapid diagnosis to prevent irreversible joint damage. Synovial fluid leukocyte esterase (LE) dipstick testing is a rapid bedside alternative to conventional culture. Objective: To evaluate the diagnostic accuracy of synovial fluid leukocyte esterase for diagnosing bacterial septic arthritis and compare its performance with synovial fluid culture. Materials and Methods: This hospital-based cross-sectional observational study included 65 adults with clinically suspected bacterial septic arthritis. Synovial fluid samples underwent LE dipstick testing and microbiological culture. Dipstick readings of 2+ and 3+ were considered positive. Diagnostic performance was assessed using sensitivity, specificity, predictive values, accuracy, odds ratio, and ROC analysis. Results: Of the 65 patients, 40 (61.5%) were diagnosed with bacterial septic arthritis. Leukocyte esterase positivity was observed in 52 (80.0%) patients and showed a significant association with bacterial septic arthritis (95.0% vs. 56.0%; p=0.000225). Positive LE was identified as the strongest independent predictor of septic arthritis (OR=14.9, 95% CI: 2.8–78.5; p=0.0002). Using synovial fluid culture as the reference standard, LE demonstrated a sensitivity of 94.7%, specificity of 26.1%, PPV of 34.6%, NPV of 92.3%, and accuracy of 46.2%. Against the diagnosis of bacterial septic arthritis, sensitivity, specificity, PPV, NPV, and accuracy were 95.0%, 44.0%, 73.1%, 84.6%, and 75.4%, respectively. ROC analysis yielded an AUC of 0.78. Conclusion: Synovial fluid leukocyte esterase is a rapid, inexpensive, and highly sensitive bedside screening test that can support early diagnosis and timely management of bacterial septic arthritis while awaiting culture confirmation.

Metagenomic sequencing has revolutionized microbial ecology by enabling culture-independent analysis of complex microbial communities. Recent advancements in sequencing technologies, computational tools, and functional annotation pipelines have dramatically improved resolution, accuracy, and scalability. This review explores the evolution of metagenomic platforms (e.g., short-read, long-read, and single-cell sequencing), their applications in diverse ecosystems (human gut, environmental, industrial), and persistent challenges such as data integration and bias correction. We highlight emerging trends, including portable sequencing devices and CRISPR-based enrichment, that promise to democratize metagenomic research further.

Introduction: Congenital malformations (CMs) are a leading cause of infant morbidity and mortality worldwide, with prevalence rates varying across regions. In India, congenital anomalies contribute significantly to neonatal and under-five mortality. Understanding maternal knowledge and awareness of CMs and their preventable risk factors is crucial for effective intervention strategies. This study aims to assess the knowledge and awareness of CMs amongst pregnant women in India and identify factors influencing their understanding of risk factors and preventive measures. Materials and Methods: A hospital-based cross-sectional study was conducted amongst 151 pregnant women attending antenatal clinics. Data was collected using a structured questionnaire covering sociodemographic details, knowledge of CMs, risk factors and preventive strategies. Statistical analysis was performed using SPSS v25, employing descriptive statistics, Pearson correlation and multivariate regression analysis. Results: Most participants (64.2%) were aged 26–35, and 52.7% had completed high school. Overall, 89.4% demonstrated a moderate level of knowledge about CMs. While most participants (92.1%) recognised alcohol consumption as a risk factor, misconceptions persisted, with 65.6% believing supernatural forces could cause congenital disabilities. Higher education levels and antenatal care attendance were significantly correlated with better knowledge of CMs and their prevention. Conclusion: Despite moderate awareness, knowledge gaps and cultural misconceptions remain prevalent. Strengthening educational interventions, promoting antenatal counseling and addressing misinformation can enhance maternal understanding of CMs, ultimately reducing neonatal morbidity and mortality in India.

Multiple sclerosis (MS) is a chronic inflammatory and neurodegenerative disorder characterized by focal and diffuse white matter (WM) abnormalities that may extend beyond lesions visible on conventional magnetic resonance imaging (MRI). Diffusion tensor imaging (DTI) and magnetic resonance spectroscopy (MRS) provide complementary information regarding WM microstructural integrity and neurochemical alterations. This systematic review aimed to evaluate WM microstructural and neurochemical alterations in MS and examine the reported associations between DTI-derived diffusion metrics and MRS-derived metabolic markers. A systematic literature search was conducted for studies published from January 2002 to 2026 that evaluated MS using DTI and MRS. Data on study characteristics, clinical phenotype, diffusion metrics, MRS-derived metabolites, and DTI–MRS associations were extracted. Owing to the limited number of eligible studies and substantial heterogeneity in MRI protocols, diffusion parameters, MRS measures, and reported correlations, quantitative meta-analysis was not performed. Findings were synthesized narratively. Two studies met the eligibility criteria. Both evaluated normal-appearing WM using DTI and MRS. Reduced fractional anisotropy and increased diffusivity, including apparent diffusion coefficient and mean diffusivity, indicated altered WM microstructural integrity. MRS demonstrated alterations in N-acetylaspartate, choline, creatine, and related metabolite ratios. Significant associations between diffusion and metabolic measures were reported. DTI and MRS demonstrate complementary WM microstructural and neurochemical alterations in MS. Further studies using standardized multimodal MRI protocols and larger clinically characterized populations are needed to validate these associations.

Introduction: Acute non-traumatic abdominal pain is a frequent emergency presentation, associated with a wide range of possible differential diagnoses. While Ultrasonography (USG) is widely available and radiation-free, its diagnostic accuracy is limited by the patient’s habitus and bowel gas. Multi-slice Computed Tomography (MSCT) offers a comprehensive evaluation but comes with a higher cost and increased radiation exposure. Aim: To assess the diagnostic accuracy of MSCT in adult patients with acute non-traumatic abdominal pain negative or inconclusive for USG. Materials and Methods: The present prospective observational study was conducted in the Department of Radiodiagnosis at Teerthanker Mahaveer Medical College and Research Centre, Moradabad, Uttar Pradesh, India over a period of one year from June 2024 to July 2025. In this study, 81 adult patients who were referred for CT after an inconclusive/negative USG report underwent contrast-enhanced MSCT using a 128-slice scanner. CT findings were compared with surgical and histopathological outcomes when available, and with clinical follow up in conservatively managed cases. The sensitivity, specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV), as well as the diagnostic accuracy of MSCT in cases of non-traumatic acute abdominal pain were calculated. Results: The mean age was 41.3±15.8 years, out of which 47 (58%) patients were male. MSCT diagnosed 16 (25.9%) cases of pancreatitis, 7 (16%) cases of appendicitis, and 5 (13.6%) cases of ureteric calculi among the most common pathologies. Among the 47 patients who got operated, CT findings were concordant with intraoperative results in 37 (90.2%) patients and with histopathology in all 41 patients (100%). MSCT provided new or alternative diagnosis in 66 out of 81 (81%) cases, significantly altering the management plans. Conclusion: The prompt use of MSCT in cases of an acute abdomen with equivocal USG findings significantly improves diagnostic accuracy and ensures appropriate management, outweighing its higher cost and radiation risks.