Background: Arthroscopic anterior cruciate ligament reconstruction (ACLR) with hamstring tendon (HT) autografts is very popular, and could result in knee flexion weakness and harvest-related morbidity. An alternative of constant diameter, with arguably reduced donor-site morbidity, has developed in the form of the peroneus longus tendon (PLT) at the expense of ankle function. Methods: It was a prospective randomized self-controlled study that was undertaken in a tertiary orthopaedic unit (2023-2025). The participants were randomly divided into 30 individuals with isolated unilateral ACL rupture who received ACLR with either PLT autograft (n=15) or quadrupled HT autograft (n=15). The measurement of functional outcomes was preoperative, 1.5, 3, 6 months using Modified Cincinnati Score (MCS), Lysholm score, and Subjective IKDC 2000. Donor-site complications were measured using AOFAS (PLT group), thigh circumference deficit, sensory symptoms, pain, ankle range of motion, and handheld dynamometry-based strength. Knee stability was evaluated using Anterior Drawer, Lachman, Pivot Shift and KT-1000 arthrometer at the follow-up. Independent t-tests/Mann-Whitney U tests and chi-square tests were conducted in groups (due to the independent test, 1=0.05). Results: PLT had more mean graft diameter than HT (8.68±0.23 mm; and 7.65±0.59 mm, respectively, p<0.001). Both groups had also improved but at 12 months, PLT had better MCS (90.1±2.9 vs 86.8±2.7), Lysholm (89.9±3.8 vs 86.3±2.1) and IKDC (92.4±4.3 vs 89.1±5.2) (all p<0.05). With enduring effects, recovering the stance favoring PLT actions and dynamics with time of 3 months and above, there was less KT-1000 side-to-side difference in final follow-up (1.2±0.5 vs 1.8±0.6 mm, p<0.01). PLT had a reduced donor-site morbidity (thigh deficit 0.520.2 cm vs 1.22.04 cm, p=0.001), and comparable outcomes of the ankle near outcome normalcy at 12 months (AOFAS 97.62.4). Conclusion: Even though PLT autograft ACLR yielded thicker grafts, faster mobilization, better 12-month stability and less donor-site morbidity and ankle functionality, it helps to support the idea that PLT is a strong alternative to HT in primary ACLR.
Introduction: CSOM is often associated with recurrent infections, leading to permanent damage to the ear structures. While the pathogenesis of CSOM is complex and multifactorial, bacterial infections play a major role, with Pseudomonas aeruginosa emerging as one of the most frequent pathogens responsible for this condition Objective: This study aims to determine the prevalence of Pseudomonas aeruginosa isolates in patients with chronic suppurative otitis media (CSOM) and to evaluate the antibiotic resistance patterns of these isolates, with a specific focus on imipenem resistance. Methods: A retrospective study was conducted on 60 patients diagnosed with CSOM at a tertiary care hospital. Ear swab samples were collected and cultured for bacterial isolation. The isolates were identified, and antibiotic susceptibility testing was performed using the disk diffusion method to assess resistance, especially to imipenem. Results: Out of the 60 CSOM-positive cases, 44% were infected with Pseudomonas aeruginosa. The majority of isolates were Gram-negative bacteria (78%), with Pseudomonas aeruginosa being the most prevalent. Of the 26 Pseudomonas aeruginosa isolates, 42.3% showed resistance to imipenem. Other significant pathogens included Klebsiella spp. and Escherichia coli. Resistance to multiple antibiotics, including imipenem, was observed, underscoring the challenge of treating CSOM infections effectively. Conclusion: Pseudomonas aeruginosa is a significant pathogen in CSOM, with a high rate of imipenem resistance. The study highlights the importance of regular bacterial cultures and antibiotic susceptibility testing for the proper management of CSOM and the need for strict antibiotic stewardship programs to combat resistance.
A complex interaction of neurological, environmental, and hereditary factors results in psychological diseases. Emerging studies in epigenetics provide a revolutionary lens through which we can comprehend the dynamic control of gene expression without changing the underlying DNA sequence, whereas classic models have mostly concentrated on inherited predispositions and neurochemical imbalances. The genesis, course, and response to therapy of conditions like depression, schizophrenia, bipolar disorder, and anxiety are increasingly being linked to epigenetic mechanisms, including DNA methylation, histone modification, and non-coding RNAs. This study examines what is now known about the epigenetic modification of genes related to neurodevelopment, stress response, and synaptic plasticity. It also looks at how trauma, early-life hardship, and lifestyle choices might leave enduring epigenetic traces that affect mental susceptibility throughout life.
Background: Surgical site infections (SSIs) remain one of the most common postoperative complications worldwide, contributing significantly to morbidity, prolonged hospitalization, and increased healthcare costs. The global incidence varies widely from 1% to 30% depending on surgical type and patient-related factors. Recent studies report prevalence rates ranging between 5% and 12% in well-equipped tertiary care settings. Aim: To determine the prevalence and risk factors associated with surgical site infections among postoperative patients. Methods: A hospital-based cross-sectional study was conducted among 128 postoperative patients. Data regarding demographic variables, type of surgery, comorbidities, and perioperative factors were collected and analyzed. Results: The overall prevalence of SSI was 10.2% (n=13). Higher infection rates were observed in contaminated and dirty surgeries. Significant risk factors included diabetes mellitus, obesity, smoking, prolonged duration of surgery (>2 hours), and extended hospital stay. Similar findings have been reported in recent studies, where SSI incidence ranged from 9.3% to 11.7% with comparable risk factors. Conclusion: SSI remains a significant postoperative complication despite advancements in surgical care. Identification and modification of risk factors can substantially reduce infection rates and improve patient outcomes.
Primary extranodal non-Hodgkin lymphoma (NHL) is a rare disease contributing 5% of all NHL. Our aim isto describe the clinical presentation of extranodal lymphoma at various sites with focusing treatment aspect
Background: Aluminum Phosphide Poisoning is a highly lethal form of pesticide poisoning commonly seen in developing countries. It leads to severe metabolic toxicity, refractory shock, malignant arrhythmias, and high mortality. Survival following cardiac arrest is rare. Case Presentation: We report a case of a 30-year-old male who presented with aluminum phosphide ingestion, severe hypotension, and altered sensorium. During hospitalization, the patient developed pulseless ventricular tachycardia requiring cardiopulmonary resuscitation and defibrillation. With aggressive intensive care management including ventilatory support, vasopressors, and supportive therapy, the patient survived and was discharged in stable condition. Conclusion: Early aggressive resuscitation, timely defibrillation, and multidisciplinary critical care support can improve survival in severe aluminum phosphide poisoning complicated by cardiac arrest.
Dengue fever, a mosquito-borne viral disease, continues to pose significant public health challenges, particularly in tropical and subtropical regions. Despite ongoing prevention efforts, the global incidence of dengue has increased in recent years, with outbreaks occurring more frequently in both urban and rural areas. This study aims to examine the prevalence of dengue, focusing on demographic variables such as age, gender, and geographic distribution, along with seasonal patterns and clinical manifestations. A total of 2,000 dengue cases were analyzed, with findings showing that the highest number of cases occurred in individuals aged 10-20 years, and that males were more frequently affected than females. Urban areas accounted for 70% of the total cases, with the majority of cases observed during the wet season, highlighting the role of climatic conditions in transmission. Clinical symptoms included fever (100%), rash (70%), joint pain (60%), and headache (75%). Severe forms of dengue, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), were observed in 10% of cases, with bleeding being the most common severe symptom. These results underscore the need for targeted mosquito control programs, early diagnosis, and effective clinical management to mitigate the growing burden of dengue. The study’s findings contribute to a better understanding of the epidemiological trends and clinical features of dengue, which are essential for designing more effective public health strategies.
Background: After cardiac valve replacement surgery, there is a pronounced inflammatory response and heightened metabolic rate. The adequacy of nutrition may affect immune modulation, recovery parameters, and quality of life (QOL), but there is a paucity of combined prospective data. Objective: To assess the effect of postoperative nutritional status on inflammation, recovery, and QOL in patients undergoing cardiac valve replacement surgery. Materials and Methods: A prospective observational study was performed from January 2026 to March 2026 in a tertiary care cardiothoracic surgery unit. A total of 250 adult patients (18-80 years) undergoing elective aortic, mitral, or double valve replacement surgery were studied. Postoperative nutritional status was determined by dietary and biochemical parameters (calorie and protein intake, serum albumin, prealbumin, hemoglobin, vitamin D, and omega-3 fatty acid intake), and patients were classified as having adequate, moderate, or poor nutrition. Inflammatory response was measured by CRP levels (Day 1, Day 3, and Day 7). Recovery parameters included wound healing score, ejection fraction (EF), and ambulation time. QOL was measured by SF-36/WHOQOL-BREF questionnaires at baseline (discharge), 1 month, and 3 months. Statistical analysis included descriptive and comparative statistics using independent t-test/ANOVA, with p<0.05 considered significant. Results: Mean age was 56.27 ± 12.74 years, with 133 (53.2%) male and 117 (46.8%) female patients. CRP values reduced in all nutritional groups from Day 1 to Day 7. In the adequate nutrition group, mean CRP reduced from 30.43 ± 12.51 (Day 1) to 21.03 ± 11.96 (Day 7). Comparison between adequate and poor nutrition groups revealed no statistically significant difference in CRP values on Day 1 (p=0.973), Day 3 (p=0.975), and Day 7 (p=0.937). Recovery rates were in favor of the adequate nutrition group, with higher wound healing score (7.50 ± 1.70 vs 7.02 ± 1.64, p=0.155), slightly higher EF (55.12 ± 5.83 vs 53.90 ± 5.76, p=0.329), and earlier ambulation (3.82 ± 1.42 vs 4.24 ± 1.51 days, p=0.228) compared with the poor nutrition group. QOL scores improved progressively in all groups; at 3 months, QOL scores were higher in the adequate nutrition group (73.33 ± 5.11) compared with the poor nutrition group (71.57 ± 5.66), with a near-significant trend (p=0.095). Conclusion: Nutritional adequacy postoperatively showed consistent favorable trends towards recovery and 3-month QOL post cardiac valve replacement surgery, while the lack of statistically significant difference in early postoperative CRP levels between adequate and poor nutrition groups was noted.
Graph query paradigms, which are popularized by data engineering, are highly efficient with complex, connected data in comparison to traditional SQL. Multi-join operations are exponentially complex in relational systems. Graph benefits may need expensive migration or ETL to specialized databases, which are hard to use with heterogeneous environments. Based on PuppyGraph's zero-ETL querying over relational and lakehouse target sources, this paper introduces a single overall graph query engine as a lightweight overlay. This solution is compatible with a wide variety of backends (RDBMS, NoSQL (MongoDB, Cassandra), big data (Hadoop/Spark), columnar (ClickHouse), and parquet-based Iceberg tables). It eradicates migration, achieves better storage efficiency through compression, increases security through column-level encryption and snapshots, and increases performance. Significant innovations are conditional lazy materialization to optimize Parquet/Iceberg with high-hop (>5), long-running (>5 s), or repeated (>= 3 in 24 hours) queries; a federation layer to hybrid cross-database queries; and graph optimization, such as index-free adjacency and rewrite rules. Experiments on reduction in versions of TPC-H and LDBC SNB-like graphs indicate a 55-70% reduction in latency on 3-10+ hop traversals, and a 40% reduction in storage by Iceberg compression and selective materialization. This can be achieved through introducing graph analytics to polyglot infrastructures without interference, redundancy, and data movement.
Background: Postoperative sore throat (POST) remains one of the most common complications following endotracheal intubation under general anaesthesia, with an incidence ranging from 21% to 65%. It results from mechanical trauma, mucosal ischemia, inflammation, and nociceptive activation during airway instrumentation. Various pharmacological strategies have been explored to mitigate POST, among which preoperative nebulization offers a simple, non-invasive, and effective approach. Agents such as dexmedetomidine, ketamine, and magnesium sulphate possess anti-inflammatory, analgesic, and NMDA receptor-modulating properties that may reduce airway irritation and postoperative discomfort. Objective: To compare the efficacy of nebulized dexmedetomidine, ketamine, and magnesium sulphate in preventing postoperative sore throat in patients undergoing elective laparoscopic surgeries under general anaesthesia. Methods: This randomized, double-blind study included 135 adult patients divided equally into three groups (n=45 each). Group D received dexmedetomidine nebulization, Group K received ketamine, and Group M received magnesium sulphate prior to induction. POST incidence and severity were assessed at 0, 2, 6, 12, and 24 hours postoperatively. Hemodynamic parameters and adverse effects were also recorded. Results: Dexmedetomidine significantly reduced both incidence and severity of POST compared to ketamine and magnesium sulphate (p<0.05). Magnesium sulphate showed the highest incidence of POST. Hemodynamic stability was superior in dexmedetomidine group, although higher sedation and bradycardia were observed. Conclusion: Preoperative nebulized dexmedetomidine is more effective than ketamine and magnesium sulphate in reducing POST, making it a preferable agent in clinical practice.
Background-More research was needed to determine whether metformin use could impact the risk of oral cancer. Methods: During 2015-2025, patients with type 2 diabetes mellitus who had recently started taking metformin (n = 288198, “ever users of metformin”) or other antidiabetic medications (n = 16263, “never users of metformin”) were monitored for oral cancer for at least six months until December 31, 2011.Cox regression adjusted for propensity score (PS) or integrated with the inverse probability of treatment weighting (IPTW) using PS was used to evaluate the treatment impact of metformin (forever versus never users, and for tertiles of cumulative length of therapy). Results- There were also 1273 (0.44%) and 119 (0.73%) occurrence cases of cancer of the mouth among ever users and never users, respectively, with rates of 92.7 and 163.6 per 100,000 person-years. A substantially decreased risk was indicated by the overall hazard ratios (95% CIs) [0.584 (0.483-0.707) for the PS-added model and 0.562 (0.465-0.678) for the IPTW approach]. The PS-adjusted hazard ratios (95% confidence intervals) for the first (<21.5 months), second (21.5-45.9 months), and third (>45.9 a period of time tertiles of cumulative time span were 1.403 (1.152-1.708), 0.557 (0.453-0.684), and 0.152 (0.119-0.194) for IPTW. Conclusions- The possibility of developing oral cancer may be considerably decreased by metformin, particularly if the cumulative period exceeds 21.5 months.
Background: Sodium valproate is commonly used in clinical practice, and maintaining appropriate drug levels is important for effective treatment and safety. Aim: To assess sodium valproate levels in patients receiving therapy. Materials and Methods: A cross-sectional study was conducted on 100 patients receiving sodium valproate. Drug levels were measured under steady-state conditions. Patients were grouped into low, normal, and high levels based on standard reference ranges. Data were analyzed using simple descriptive statistics. Results: Out of 100 patients, 62% had normal levels (50–100 µg/mL), 24% had low levels (<50 µg/mL), and 14% had high levels (>100 µg/mL). The mean level was 68.5 ± 17.6 µg/mL, with values ranging from 33 to 118 µg/mL. Conclusion: Most patients had sodium valproate levels within the normal range, but a considerable proportion showed levels outside the desired range. Monitoring drug levels can help in better management.
The quick growth of clinical data in oncology research has made it difficult to extract and manage data which needs to be processed for clinical trials. The medical field considers manual curation to be the highest standard but its use has become restricted because of time and financial requirements and difficulties with different people judging the same material. Large Language Models (LLMs) which belong to artificial intelligence research work as effective automatic systems which can extract data from unstructured clinical documents that include electronic health records and pathology reports and clinical narratives. This review assesses how well LLMs perform data curation in oncology clinical trials by comparing their results to those of manual data curation processes. This research project has been collecting current evidence about accuracy and efficiency and scalability and reliability and cost-effectiveness of the solution. The study examined validation frameworks together with ethical matters and difficulties which arise during system implementation. Existing studies demonstrate that LLM-based approaches achieve high concordance with manual curation while dramatically reducing processing time and resource utilization. The system suffers from multiple problems which include data heterogeneity and difficulties with understanding data and bias issues and challenges from regulatory bodies. Hybrid human-AI models appear to be the most viable approach for near-term clinical integration. The review presents major advancements in research while showing existing research deficiencies and giving recommendations about how to use LLM-based systems in oncology clinical trial operations.
Male infertility is a significant reproductive health issue, with infectious agents playing a crucial role in its pathophysiology. This study aimed to evaluate the microbial profile of bacteria in male infertility patients and their impact on seminal fluid quality. A total of 100 male infertility patients were enrolled, and their semen samples were analyzed for bacterial infections. The most common pathogens identified were Escherichia coli, Enterococcus faecalis, and Staphylococcus aureus. The presence of bacterial pathogens was associated with lower sperm count, motility, and increased abnormal sperm morphology. Additionally, a high antibiotic resistance profile was observed among the isolates. The findings suggest that bacterial infections are a significant contributor to male infertility and highlight the need for proper diagnosis and management of infections in infertile men.
This theoretical research examines how the COVID-19 pandemic intensified psychosomatic experiences among women. Psychosomatism—the manifestation of psychological stress through physical symptoms—is deeply influenced by biopsychosocial and gender-role dynamics. Drawing on established theories such as the Biopsychosocial Model, Gender Role Theory, Stress-Diathesis Model, and Trauma-Stress Response Theory, this paper conceptualises why women experienced heightened psychosomatic distress during the pandemic. It argues that the pandemic magnified structural inequalities, emotional labour, domestic responsibilities, and caregiving roles, leading to greater mind–body conflict and physical symptom expression. As a theoretical exploration, the study synthesises interdisciplinary perspectives to understand women’s psychosomatic vulnerability in crisis contexts.
Background: Acute febrile illness (AFI) is a leading cause of pediatric visits and admissions worldwide. The nonspecific presentation of AFI and broad etiological spectrum present diagnostic and therapeutic challenges, particularly in low- and middle-income countries. Objective: To describe the clinical features, laboratory profile, etiological distribution, complications and outcomes of children presenting with acute febrile illness to a tertiary care hospital. Methods: Hospital-based observational study including children aged 1 month–14 years with fever ≤14 days (n = 100). Standardized history, physical exam, and investigations (CBC, peripheral smear, CRP, urine analysis, blood culture, disease-specific tests such as dengue NS1/IgM, malaria antigen/smear, Widal, scrub typhus IgM) were performed. Data were tabulated and analyzed descriptively. Results: Among 100 children, median age distribution showed predominance in 1–5 years (36%) with male:female = 56:44. Common symptoms included vomiting (48%), cough (42%), and headache (34%). Etiologies identified: viral fever (34%), dengue (18%), enteric fever (12%), malaria (10%), bacterial sepsis (8%), UTI (8%), pneumonia (6%), scrub typhus (4%). Complications occurred in 30% (shock 8%, bleeding 10%, seizures 6%), mortality 2%. Median hospital stay was 4–7 days in 46%. Conclusions: Viral illnesses remain the most frequent cause of AFI, but dengue, enteric fever, malaria, and bacterial infections are important contributors. A protocolized approach with region-specific diagnostic testing improves etiological yield and guides management.
