Thanjavur Medical College

BACKGROUND:Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are modifiable determinants of adverse maternal and neonatal outcomes. This study evaluated the association of BMI and GWG, based on 2009 Institute of Medicine (IOM) recommendations, with fetomaternal outcomes in a tertiary care setting. METHODS:A prospective cohort study was conducted among 300 singleton pregnant women aged 20-34 years attending a tertiary hospital. Women were categorized by pre-pregnancy BMI (underweight n=90, normal n=120, overweight n=60, obese n=30) and GWG class (appropriate n=146, excess n=56, inadequate n=98). Maternal and neonatal outcomes were compared using chi-square/Fisher's exact tests. A p-value <0.05 was considered statistically significant. RESULTS:Obese women were predominantly ≥30 years (18; 60%) (p<0.001) and had higher lower-segment caesarean section (LSCS) rates (16; 53.3%) (p<0.001). Post-term delivery was common in overweight and obese groups (36; 60% and 18; 60%) (p<0.0001), while preterm delivery was higher in underweight women (35; 38.9%) (p<0.0001). Delayed wound healing increased with BMI, peaking in obese women (19; 63.3%) (p<0.0001). In GWG analysis, inadequate gain was strongly associated with preterm delivery (72; 73.5%) (p<0.001), whereas excess gain was linked to post-term delivery (36; 64.3%), induction (39; 69.6%), and LSCS (26; 46.4%) (p<0.001). Neonatally, macrosomia was highest in obese (11; 36.7%) and excess GWG (21; 37.5%) groups (p<0.001), while low birth weight was concentrated in inadequate GWG (70; 71.4%) (p<0.001). NICU admissions were highest in obese BMI (18; 60%) and inadequate GWG (68; 69.4%) (p<0.001). CONCLUSION:Extremes of BMI and GWG are associated with adverse maternal and neonatal outcomes. Optimizing pre-pregnancy BMI and maintaining appropriate GWG may substantially improve fetomaternal outcomes.

Introduction: Acute appendicitis is a common cause of acute abdominal pain, which should be appropriately diagnosed, so that the subsequent perforation, or unjustified surgeries, may be prevented. The use of Artificial Intelligence (AI) powered structures can combine clinical and imaging data to enable faster, more precise detection. Aim: To develop an automated system for detecting acute appendicitis using Convolutional Neural Networks (CNNs) and Generative Adversarial Networks (GAN)- based data augmentation. Materials and Methods: A retrospective observational study has been conducted at the General Medicine Unit, Vinodhagan Memorial Hospital, Thanjavur, Tamil Nadu, India from January 2022 to June 2025, to analyse clinical data from 500 patients, of whom 100 underwent Contrast-enhanced Computed Tomography (CECT) scans according to clinical indications. The training input included 70 original CT images, which were enhanced using a GAN to produce 140 synthetic images, for a total of 210 training images. The validation set (10 images) and Independent test set (20 images) consisted solely of original CT-acquired images to avoid bias in evaluating the model. A Feedforward Neural Network (FNN) was used to process the clinical symptoms (body temperature, abdominal pain, nausea, and appetite loss) and provide the probability of appendicitis. The CT Images of high probability patients were collected for further analysis. The analysis of CT images was processed using a three-dimensional Residual Network (3D ResNet)-based CNN. GANs were used to generate synthetic images to improve model robustness through data augmentation. The system was evaluated based on accuracy, sensitivity, specificity, and F1 score, and the results were compared with surgical outcomes. Results: The image-based CNN with GAN augmentation produced the best diagnostic results with an accuracy of 90%, precision of 0.91, recall of 0.91, F1 score of 0.91, specificity of 0.89, and AUC-ROC of 0.90. The FNN model, which uses symptoms as the independent variable, achieved an accuracy of 80% and an AUC-ROC of 0.81. The CNN baseline with no augmentation got the 85% accuracy and an AUC-ROC of 0.85. Conclusion: GAN-based augmentation improves model generalisation on small datasets. The model has great potential for clinical implementation, thereby preventing misdiagnosis and unnecessary surgeries.

Acute exacerbations of chronic periapical pathology require prompt surgical or endodontic intervention, supported by pharmacotherapy. The role of analgesic selection, escalation, and rotation in acute dental pain remains underexplored. A 39-year-old male dentist with a 27-year history of trauma to the lower left central incisor presented with acute pain of three hours' duration. The tooth was non-vital with a stable periapical granuloma documented for over 15 years. Self-medication began with paracetamol, escalating to ibuprofen, aceclofenac, and etoricoxib, when pain worsened. Amoxicillin and metronidazole were also taken for infection control. On day three, endodontic access without anesthesia yielded minimal pus drainage but immediate pain relief. The canal was initially left open, then medicated with calcium hydroxide, and finally obturated with gutta-percha and zinc oxide-eugenol sealer. Three years of follow-up showed no recurrence. This case demonstrates symptom-driven analgesic escalation and de-escalation in an informed patient and raises the concept of analgesic rotation for reducing cumulative toxicity. While this may be relevant in chronic pain management, its role in acute odontogenic pain is limited, especially for agents with shared adverse profiles such as non-steroidal anti-inflammatory drugs (NSAIDs). Timely endodontic intervention remains the cornerstone of treatment for acute periapical abscesses. Analgesic prescribing should be individualized and symptom-based rather than fixed-duration, with rotation considered selectively.

Salmonella enterica (S. enterica) is an important pathogen responsible for bloodstream infections, particularly in developing nations. These infections often lead to bacteremia, with a few patients developing cardiac complications in high-risk populations. Myocarditis, a common manifestation, presents with fever, chest pain, and dyspnea and can lead to severe complications, such as cardiogenic shock. Salmonella endocarditis, although rare, predominantly affects the mitral valve and leads to critical complications, including valve perforation and dehiscence, with a high mortality rate. Patients with purulent pericarditis present more acutely with toxic features. Arrhythmias, notably third-degree atrioventricular block and ventricular fibrillation, are prevalent complications primarily due to myocarditis. Diagnostic methods range from isolating Salmonella from clinical samples to immunoblotting and polymerase chain reaction-based assays that target specific genes. Depending on severity, treatment includes supportive care or antibiotic therapy with fluoroquinolones in uncomplicated cases and cephalosporins in complicated cases. Timely diagnosis and appropriate management strategies are crucial for mitigating the morbidity and mortality associated with S. enterica infections.