Total knee replacement is a treatment for end-stage knee osteoarthritis that reduces pain and restores function, but is often limited by plateaued neuromuscular function, such as reduced corticomotor excitability, which may have long-term implications for health and Quality of Life (QoL). Sensorimotor training along perturbation exercises is a relatively new technique of neurophysiological rehabilitation which can stimulate the activity of the cortex and motor control. Although the quadriceps functions as a muscle group, the vastus medialis was specifically assessed because it is highly affected by arthrogenic muscle inhibition after Total Knee Arthroplasty (TKA) and plays a key role in knee stability. The present case report examined the effects of sensorimotor training along perturbation exercises on the vastus medialis corticomotor excitability of a patient with a TKA. In the present report the objective and the subjective outcome measures were used. After unilateral TKA, a 58-year-old female patient expressed pain in knee {Numeric Pain Rating Scale (NPRS) 4/10}, stiffness of knee, and difficulty climbing stairs and standing long, 4 weeks after surgery. The clinical results were knee flexion being 95°, extension lag 10° and quadriceps strength was 3/5 on Medical Research Council (MRC) scale. The initial examination revealed a lower level of corticomotor excitability; Motor Evoked Potential (MEP) amplitude was 0.42 mV, Resting Motor Threshold (RMT) was 65%, Timed Up and Go (TUG) time was 15.1 s, NPRS score was 4/10, knee Range of Motion (ROM) was 0-95°, extension lag was 10°, and quadriceps strength was MRC grade 3/5. The Knee Injury and Osteoarthritis Outcome Score (KOOS) subscale scores were out of 100; 54 for pain, 55 for symptoms, 56 for Activities of Daily Living (ADL), 50 for sports/ recreation, and 52 for QoL. The patient received a sensorimotor training along perturbation exercises was administered three times weekly for four weeks (12 sessions), with each 45-minute session comprising a 10-minute warm-up, 30-minute training period, and 5-minute cool-down. Conventional exercises and home advice were provided on non treatment days. The post-intervention results showed that significant changes in the corticomotor excitability and functional performance were observed. MEP amplitude increased by 0.43 mV (0.42 to 0.85 mV) and RMT decreased by 11 (65% to 54%). TUG time decreased by 4.9 s (15.1 to 10.2 s), NPRS score decreased by three points (4/10 to 1/10), knee ROM increased by 20° (0-95° to 0-115°), extension lag reduced by 8° (10° to 2°), and quadriceps strength improved from MRC grade 3/5 to 4/5. KOOS subscale scores improved by 28 points for pain (54 to 85), 27 points for symptoms (55 to 82), 31 points for ADL (54 to 85), 30 points for sports/recreation (50 to 80), and 31 points for QoL (52 to 83). The findings of the present case report suggests that sensorimotor training along perturbation exercises may serve as an adjunct to conventional rehabilitation strategies to promote corticomotor excitability and functional activities following TKA. However, further controlled trials are needed to prove its effectiveness.
Introduction: In regional anaesthesia, a rapid onset of analgesia was clinically important because it improved patient comfort and may reduce the need for rescue analgesics. Evaluating the efficacy of a drug as an adjuvant can help identify approaches to achieve faster, more effective postoperative pain control. Aim: To assess the efficacy of 0.5% ropivacaine with magnesium sulfate versus 0.5% ropivacaine alone in ultrasound-guided supraclavicular brachial plexus block. Materials and Methods: This prospective observational study was conducted in the main Operation Theatre (OT) of the Department of Anaesthesia, Kottayam Government Medical College, Kottayam, Kerala, India, from July 2023 to July 2024. The study included American Society of Anaesthesiologists (ASA) physical status I and II patients aged 18-65 years posted for upper limb surgeries under ultrasound-guided supraclavicular block. Patients having peripheral neuropathy, bleeding disorders, and allergies to local anaesthetics or magnesium sulfate were excluded. Consecutive sampling resulted in 52 patients receiving 0.5% ropivacaine with 150 mg magnesium sulfate (Group A) and another 52 receiving 0.5% ropivacaine alone (Group B). The primary outcome was the duration of postoperative analgesia. Secondary outcomes were the onset of sensory and motor block, postoperative pain using the Visual Analogue Scale (VAS), sedation (Ramsay) scores, rescue-analgesic requirements, and haemodynamic parameters. Demographic data were also recorded. Non normally distributed/ordinal outcomes were compared by Mann-Whitney U, categorical rescue analgesia by Fisher’s-exact test, and haemodynamics by repeated-measures Greenhouse-Geisser; effect sizes and per-family Bonferroni correction reported throughout. Results: A total of 104 patients (52 per group) were included. Baseline demographic characteristics were comparable between groups. The median duration of postoperative analgesia was similar in the magnesium and control groups {468.5 (IQR 155) vs 470.0 (IQR 129) min; p=0.610}. The magnesium group had a faster onset of sensory block {15.0 (IQR 10) vs 18.5 (IQR 5) min; p=0.042} and motor block {15.0 (IQR 10) vs 18.0 (IQR 5) min; p=0.042} and this difference remained significant after Bonferroni correction (VAS at postoperative 6 h was significantly lower in Group A than in Group B [p=0.007], α=0.0083). Paracetamol consumption was comparable between groups, whereas fewer patients in the magnesium group required tramadol rescue analgesia (42.3% vs 75.0%; adjusted OR 3.92, 95% CI 1.66– 9.25; p=0.002). Early postoperative sedation was higher in the magnesium group {0 h: 4.0 (IQR 0) vs 3.0 (IQR 1); p<0.001}, with no clinically significant haemodynamic differences. Conclusion: Adding magnesium sulfate to 0.5% ropivacaine did not significantly prolong the duration of postoperative analgesia. However, it was associated with reduced postoperative tramadol requirements and increased early sedation, while maintaining haemodynamic stability
Pregabalin is often prescribed to relieve neuropathic pain and is largely tolerated very well. Myoclonus as an adverse effect of pregabalin use is an infrequent occurrence that may go unrecognised. This case describes a 62-year-old female patient who developed myoclonus shortly after dose escalation of pregabalin from 75 mg twice daily to 150 mg twice daily, raising concerns about an acute underlying neurological condition. An extensive evaluation revealed no evidence of a structural, metabolic, infectious, epileptic, endocrine or toxic cause. The close temporal relationship between the onset of positive myoclonus and the use of pregabalin, along with the return of the patient to her baseline physical and neurological state following discontinuation of the drug, supported the diagnosis of pregabalin-induced positive myoclonus. Physicians should perform a thorough medication review for the identification of potential adverse drug reactions, exclude other possible diagnoses, and withdraw the use of pregabalin in order to ensure that the patient has a complete return to a normal neurological state.
Inverse psoriasis is an uncommon variant of psoriasis involving flexural and intertriginous areas. Because of the warm and moist environment of these regions, lesions often have minimal scaling and may clinically resemble dermatophytosis, particularly in children, resulting in delayed diagnosis and inappropriate treatment [1,2].An 11-year-old boy presented to the department of Paediatrics with complaints of itching and reddish lesions over the genital region for the past three months. The lesions were initially noticed over thescrotum and gradually extended to involve both inguinal folds. The condition had been progressive and was associated with intenseitching. There was no history of fever, weight loss, trauma, recent drug intake, or any systemic illness. Similar lesions were not presentelse where on the body. There was no personal or family history suggestive of psoriasis, atopy, or autoimmune disease. The child had received immunisations appropriate for his age according to the national immunisation schedule, and his developmental milestones were normal.
Introduction: With changing lifestyle patterns, sedentary behaviour has increased significantly, often coexisting with low levels of physical activity. While both factors are known to influence health, their combined association with functional exercise capacity has not been explored extensively, particularly in Indian populations. Understanding this relationship is important because it helps to identify lifestyle factors that can be modified to improve daily functional performance. Aim: To examine the correlation of sedentary behaviour and physical activity with functional exercise capacity in the healthy adult population of India, with particular focus on the Gujarat region. Materials and Methods: The present cross-sectional, multicentre observational study at various hospitals, physiotherapy colleges, Physiotherapy Outpatient Departments (OPDs), and residential societies across the Ahmedabad, Vadodara, Navsari, and Dahod regions of Gujarat, India from March 2025 to March 2026. The study included 713 apparently healthy adults (407 males and 306 females) aged 18-60 years. Sedentary behaviour and physical activity levels were assessed using the Global Physical Activity Questionnaire (GPAQ), while functional exercise capacity was evaluated using the Six-Minute Walk Test (6MWT). Pearson’s correlation analysis was used to examine the relationships among physical activity, sedentary behaviour, and 6MWT distance. Additionally, a One-way Analysis of Variance (ANOVA), followed by a post-hoc Tukey’s test, was used to compare the mean 6MWT distance across physical activity categories. A p-value of <0.05 was considered statistically significant for all analyses. Results: The mean 6MWT distance of the study population was 370.88±68.47 m. Male participants achieved greater walking distances than females, and performance declined with increasing age despite gender differences. 6MWT distance increased progressively across physical activity groups (p<0.001), with significant differences observed between all groups on post-hoc analysis. Correlation analysis demonstrated that prolonged sitting time was associated with lower 6MWT performance (r=-0.517, p<0.001), whereas total physical activity was associated with better 6MWT performance (r=0.398, p<0.001). No significant correlation was observed between sitting time and total physical activity (r=-0.051, p=0.173). Conclusion: Sedentary behaviour and physical activity both significantly influence functional exercise capacity. Increased sitting time is associated with reduced performance, while higher physical activity levels are linked to improved functional capacity. These findings highlight the importance of promoting an active lifestyle while simultaneously reducing sedentary time to maintain functional health in adults.
Introduction: Dentistry involves prolonged static postures and repetitive movements, predisposing practitioners to Musculoskeletal Disorders (MSD), particularly affecting the neck, shoulders, and upper back. Upper Cross Syndrome (UCS), characterised by muscle imbalance and Forward Head Posture (FHP), is highly prevalent among dental professionals. Ergonomic modifications combined with postural correction exercises may provide a cost-effective and sustainable preventive strategy. Aim: To evaluate the effect of ergonomic advice and postural correction exercises on Craniovertebral Angle (CVA), muscle strength, muscle length, pain and neck disability in postgraduate dental students with UCS Materials and Methods: The present quasi-experimental Study was conducted at the AB Shetty Memorial Institute of Dental Sciences, NITTE (Deemed to be University), Mangaluru, Karnataka, India, over a period of 10 months from February 2023 to December 2023 among 29 postgraduate dental students aged 20-30 years with neck pain measured by Numerical Pain Rating Scale (NPRS) 3-6 and FHP (CVA <49.9°). The study duration was four weeks. CVA was measured using Markus Bader (MB) ruler software. Outcome measures included Neck Disability Index (NDI), NPRS, CVA, muscle strength with handheld mynamometer, and muscle length by Janda technique. Participants underwent a structured intervention comprising pamphlet-based postural correction exercises and ergonomic advice. Data were analysed using Statistical Package for the Social Sciences (SPSS) version 20.0. Paired t-test was used for pre-post comparison and p<0.05 was considered statistically significant. Results: Post-intervention, statistically significant improvements were observed in all outcome measures. NDI decreased from 14.28±3.61 to 11.48±4.00 (p<0.001), NPRS reduced from 5.34±0.61 to 3.97±1.24 (p<0.001), and CVA increased from 46.89±1.35° to 48.08±2.13° (p<0.001). Muscle strength improved significantly in the neck flexors, middle and lower trapezius, and serratus anterior (p<0.05). Muscle length showed significant improvement, with reduced tightness in pectoralis major, pectoralis minor, and latissimus dorsi, and increased length of the upper trapezius (p<0.05). Conclusion: A four-week intervention combining ergonomic advice and postural correction exercises significantly improved CVA, muscle strength, and muscle length, and reduced pain and neck disability in dental postgraduate students with UCS. Early incorporation of ergonomic education and targeted exercise in dental training may help prevent chronic MSDs.
Juvenile Idiopathic Arthritis (JIA) represents the most common chronic rheumatologic disorder in children, encompassing a group of heterogeneous conditions with varied clinical manifestations. Juvenile Psoriatic Arthritis (JPsA) is a distinct subtype characterised by the association of arthritis with psoriasis or its related features. JPsA, a heterogeneous subtype of JIA, accounts for approximately 5% of all JIA cases, with reported ranges between 1% and 10%. An eight-year-old girl presented with subacute oligoarthritis involving bilateral hips and the right knee, along with nail pitting and minimal psoriatic skin changes, leading to a diagnosis of JPsA based on the International League of Associations for Rheumatology (ILAR) criteria. An incidental horseshoe kidney, a congenital renal anomaly with an incidence of approximately 0.2-0.25% in the general population and no established association with JPsA, was identified during evaluation. The child responded well to Non Steroidal Anti-Inflammatory Drugs (NSAIDs) and methotrexate. The present case is notable for the rare co-existence of JPsA and an incidental horseshoe kidney, with no previously established association between the two conditions. It also underscores the importance of identifying congenital renal anomalies when planning long-term immunosuppressive therapy. Although incidental, identification of such renal anomalies is clinically relevant when planning long-term anti-inflammatory and immunosuppressive therapy.
An 11-year-old child reported to the Department of Paediatric and Preventive Dentistry with the chief complaint of irregularly placed upper anterior teeth and aesthetic concern. Medical and family history was non contributory, and there was no history of trauma. Intraoral examination revealed mixed dentition. The maxillary left central incisor (21) appeared enlarged mesiodistally with a bifid incisal edge suggestive of gemination [Table/Fig-1]. A mesiodens was present in the anterior maxillary region, contributing to spacing and altered eruption pattern. The possibility of a retained deciduous incisor was ruled out based on its morphology and eruption characteristics. Fusion was also excluded, as the overall tooth count was normal and there was no evidence of union between tooth germs. The permanent maxillary right central incisor (11) was partially erupted and displaced labially. The surrounding gingiva appeared healthy without signs of inflammation
Measurable Residual Disease (MRD) is a key prognostic marker in acute leukaemias, guiding therapy and risk stratification. Even in morphologic remission, residual clones drive relapse, highlighting the need for sensitive, standardised detection. This narrative review synthesises evidence from PubMed, Embase, and Scopus (2000–2025) together with international guidelines from the European LeukaemiaNet (ELN), the National Comprehensive Cancer Network (NCCN), the World Health Organisation (WHO), and the EuroFlow Consortium (EuroFlow). Multiparameter Flow Cytometry (MFC) remains the frontline tool for its accessibility and speed, though challenged by haematogone overlap, immunophenotypic shifts, and CD19‑negative relapse. Molecular assays {Quantitative Reverse Transcription Polymerase Chain Reaction (RT-qPCR), Next-Generation Sequencing (NGS)} provide higher sensitivity but require caution in clonal haematopoiesis; DNMT3A, TET2, and ASXL1 mutations are excluded from Acute Myeloid Leukaemia (AML) Minimal Residual Disease (MRD) reporting. Standardised Breakpoint Cluster Region (BCR)::ABL Proto-Oncogene 1, Non-Receptor Tyrosine Kinase (ABL1) monitoring exemplifies harmonised molecular metrics, though broader consensus is needed. Comparative insights across B-precursor Acute Lymphoblastic Leukaemia (B-ALL), T-cell Acute Lymphoblastic Leukaemia (T-ALL) , AML, and related neoplasms reveal disease‑specific thresholds. Emerging technologies, namely, digital PCR, error‑corrected NGS, single‑cell profiling, promise unprecedented resolution, positioning MRD as a cornerstone of precision therapy.
Introduction: Odontogenic Keratocyst (OKC) is a developmental odontogenic cyst whereas ameloblastoma is a benign odontogenic epithelial tumour, and squamous cell carcinoma is a malignant epithelial neoplasm. Although OKC is classified as a cyst, its high proliferative potential and aggressive behaviour often lead to uncertainty regarding its neoplastic nature. Cellular proliferation can be assessed using Immunohistochemical (IHC) markers, among which Ki-67 is considered reliable as it is expressed in all active phases of the cell cycle (G1, S, G2, and M), making it an accurate indicator of proliferative activity. Aim: To compare the Ki-67 Labelling Index (LI) of OKC, Follicular ameloblastoma, Well-Differentiated Oral Squamous Cell Carcinoma (WDOSCC) and normal oral mucosa. Materials and Methods: The present cross-sectional study was conducted in Department of Oral Pathology, Pondicherry, Mahatma Gandhi Institute of Dental Science from June 2022 till June 2024 for a period of two years. The Study included histopathologically diagnosed, paraffin-embedded archival tissue blocks of OKC, Follicular Ameloblastoma, WDOSCC, and Normal Oral Mucosa, along with Fresh Biopsy Specimens of OKC, Follicular Ameloblastoma, WDOSCC, and Normal Oral Mucosa. A total of 48 Cases were included, comprising 12 Cases each of OKC without Inflammation (Group A), Follicular Ameloblastoma (Group B), WDOSCC (Group C), and Normal Oral Mucosa (Group D). Study was carried out using three microns paraffin embedded formalin fixed tissue sections which were stained immunohistochemically with Ki-67 antibody and its Labelling Index (LI) was evaluated by manual counting of 10 camera-captured hotspot areas at X200 magnification on zig-zag pattern to avoid repetition. The results were later evaluated statistically by IBM SPSS Version 20.0. Mean and Standard deviation (SD) were used to summarise the data. A p-value of <0.05 was considered as statistically significant difference. Statistical tests employed are tests of normality, Oneway Analysis of variance (ANOVA) and appropriate post-hoc tests were performed for pairwise comparisons between groups. Results: All cases of WDOSCC and normal oral mucosa were Ki67 positive, whereas in contrast, positive expression was observed in 10 (83.3%) cases of OKC and 5 (41.7%) cases of Follicular Ameloblastoma. The mean labelling index of OKC was 17.13±10.40, Ameloblastoma was 2.14±2.97, of OSCC was 35.19±15.41, and of Normal oral mucosa was 19.29±4.09. Mean labelling index of WDOSCC was the highest followed by normal oral mucosa and OKC and the lowest in follicular ameloblastoma. Conclusion: The study findings highlight distinct differences in cellular roliferation among oral lesions, supporting the aggressive nature of WDOSCC and the comparatively lower proliferative potential of follicular ameloblastoma. OKC and normal oral mucosa had almost similar Ki-67 LI.
The Ilioinguinal Nerve (IIN) has a crucial role in providing sensory innervation to the groin region. The literature has extensively documented variability in IIN formation, particularly in relation to the iliohypogastric nerve. However, there is a scarcity of cadaveric studies that specifically document variations in the origin of the IIN. Herein, we report a case of an aberrant variation in the origin of the IIN. Instead of following the usual origin from the first lumbar (L1) nerve root, the right IIN was observed to arise from a broader contribution spanning the L1-L3 nerve roots, indicating an atypical, more extensive segmental origin. In contrast, the contralateral IIN followed the conventional anatomical pattern, originating solely from the L1 spinal nerve without additional contributions. Thorough knowledge of any variation concerning the IIN is crucial for surgeons, Orthopaedics, and anaesthetists, as it enables them to prevent iatrogenic injuries.
Tracheoesophageal Fistula (TEF), which is usually associated with Oesophageal Atresia (EA), is known to be a common congenital anomaly requiring urgent surgical intervention in the neonatal period. Anaesthetic management of TEF repair is very challenging because of the pathological communication between the airway and gastrointestinal tract, immature neonatal physiology, as well as frequent association with congenital anomalies, especially cardiac defects. Key aspects include the embryological basis, anatomical classification and pathophysiological implications influencing protection ventilation and airway, along with risk stratification using established prognostic systems such as the Spitz classification. Preoperative evaluation which is focused upon stabilisation strategies for minimising aspiration as well as respiratory compromise, detailed assessment for associated anomalies and optimisation of metabolic and respiratory status. Intraoperative management emphasises strategies into airway control inclusive of distal endotracheal tube placement, fibreoptic ronchoscopy-guided localisation of the fistula, lung-protective ventilation for reduction of gastric insufflation and barotrauma. Postoperative anaesthetic and critical care management including decisions regarding elective ventilation, analgesia, monitoring and the prevention of complications such as anastomotic leak and recurrent fistula are also reviewed. Advancements such as opioid-sparing multimodal analgesia, minimally invasive surgery techniques as well as protocol-based multidisciplinary care pathways have contributed further in improved perioperative outcomes. Despite such developments there are significant gaps also remains into high-quality evidence further guiding optimal ventilation strategies, extubation criteria, long-term outcomes. This narrative review article highlights cucurrent practices, recent advances, future directions into research for evidence-based anaesthetic management of TEF repair.
A 14-year-old female patient presented to the Department of Paediatric and Preventive Dentistry with a chief complaint of missing mandibular central and lateral incisors since birth with presence of all maxillary teeth. The patient also complained of missing deciduous mandibular central and lateral incisors due to which there was space loss in the mandibular anterior region. An orthopantomogram (OPG) was requested. Clinically and radiographically, the teeth were bsent, and there was no history of tooth extraction, confirming the absence of mandibular central and lateral incisors.There was no family history of missing teeth. There was no relevant past medical and dental history. Other findings include hypocalcification in 16 as well as hypoplastic central and lateral incisors (11,12,21,22). Permanent dentition was noted during this period. While the patient’s chief complaint was strictly aesthetic, the condition could also lead to functional issues, including malocclusion, periodontal damage, insufficient alveolar bone growth, compromised chewing
Acute Myeloid Leukaemia (AML) is a rapidly progressive myeloid neoplasm that is characterised by clonal expansion of immature myeloid lineage cells, known as blasts in the bone marrow and peripheral blood. It is known to present with pallor, bleeding tendencies and infections. However, Extra Medullary (EM) presentations involving the central nervous system are rare and can delay clinical diagnosis. Hereby, the authors report a case of 14-year-old male child who had a unique presentation of acute myeloid leukaemia. His initial symptoms were indicative of a central nervous system disease, and later the child was diagnosed to have acute myeloid leukaemia with spinal metastasis. A case of AML which does not routinely present with lower limb weakness and bowel or bladder dysfunction can be isolated with this case report and a crucial diagnosis can be caught early on. The present case underscores the critical need for maintaining high suspicion for haematological malignancies in children presenting with neurological deficits. It also highlights the different dimensions of the disease pathology and the disease’s rapid progression to metastasis. The key role of diagnostic imaging to isolate metastasis has also been focused on.
First Branchial Cleft Anomaly (FBCA) is an uncommon congenital anomaly that may mimic other periauricular lesions. A two-yearold male child presented with a right infra-auricular pit present at birth and eight months of intermittent painful swelling with foulsmelling whitish discharge following spontaneous rupture. An xamination showed a sinus tract scar. Computed Tomography (CT) sinogram demonstrated a tract extending toward the floor of the External Auditory Canal (EAC), consistent with a Type II first branchial cleft sinus. After the infection resolved, the cyst was completely resected while preserving the facial nerve. Histopathology revealed a cyst with a keratinising stratified squamous lining, lamellated keratin, and no adnexal or mesodermal structures, confirming an Epidermoid Inclusion Cyst (EIC).
Tethered Cord Syndrome (TCS) is a rare neurological condition caused by pathological anchoring of the spinal cord, resulting in abnormal stretching and progressive neurological deficits. Although TCS is commonly diagnosed in childhood, adult-onset cases present diagnostic and therapeutic challenges due to delayed recognition and varied clinical manifestations. The present case report describes a 38-year-old male presenting with chronic low back pain, progressive lower limb weakness and bilateral lower limb tremors, leading to impaired functional mobility and reduced quality of life. Magnetic Resonance Imaging (MRI) revealed thickening of the filum terminale, confirming the diagnosis of adult TCS. As the patient preferred conservative care, a 4-week integrated treatment program combining structured physiotherapy and Ayurveda interventions was implemented. Physiotherapy focused on pain relief, muscle strengthening, flexibility and functional rehabilitation, while Ayurveda therapies aimed to enhance neuromuscular balance and provide symptomatic relief. Clinical progress was monitored through periodic neurological and functional assessments. Following the intervention, the patient demonstrated significant improvements in pain intensity, muscle strength, lower limb tremors and overall functional performance, with no adverse effects reported. The present case suggests that integrative, non surgical management may be beneficial in adult TCS patients opting for conservative treatment and highlights the need for further controlled studies.
Hyponatraemia is a common and potentially serious condition in elderly patients. It is associated with significant morbidity including delirium, falls and prolonged hospitalisation. Antidepressant induced hyponatraemia is a recognised adverse effect, most commonly attributed to Syndrome of Inappropriate Antidiuretic Hormone Secretion (SIADH). Although Mirtazapine is often considered a safer alternative to other antidepressant-induced hyponatraemia, reports of SIADH related to its use remain limited. We report the case of a 72-year-old male with dementia and Behavioural and Psychological Symptoms of Dementia (BPSD) who developed symptomatic hyponatraemia 15 days after initiation of mirtazapine (3.75 mg/day). Evaluation revealed hypotonic hyponatraemia with a serum sodium level of 122 mEq/L, serum osmolality of 253 mOsm/kg, urine spot sodium of 31.1 mEq/L and clinical euvolaemia. Alternative causes of hyponatraemia and SIADH including adrenal insufficiency, ypothyroidism, renal dysfunction, cardiac failure, malignancy, respiratory disease, HIV infection and acute intracranial pathology were excluded. Mirtazapine was stopped while concomitant medications were continued unchanged along with fluid restriction and high-salt diet which resulted in improvement of serum sodium levels and resolution of hyponatraemia associated delirium within three days. The likelihood of Mirtazapine use causing hyponatraemia was probable (score 7) as per the Naranjo Adverse drug reaction probability scale. This case describes probable mirtazapine-associated SIADH occurring at a low dose of 3.75 mg/day in an elderly male and highlights the importance of baseline evaluation and regular monitoring of serum sodium along with vigilance for clinical signs of hyponatraemia in elderly patients and those with risk factors receiving mirtazapine although mirtazapine is considered a safer alternative for other antidepressantinduced hyponatraemia.
Introduction: Postoperative pain continues to be a major concern in patients undergoing abdominal surgeries despite advances in regional anaesthesia. Dexmedetomidine is found to have analgesic properties, hence used as an adjuvant for enhancing postoperative analgesia in both central neuraxial and peripheral nerve block. Aim: To compare the efficacy of dexmedetomidine as an adjuvant in subarachnoid block versus Transversus Abdominis Plane (TAP) block in patients posted for total abdominal hysterectomy under spinal anaesthesia. Materials and Methods: This double-blinded randomised clinical study was conducted at Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India. A total of 70 patients undergoing elective total abdominal hysterectomy under subarachnoid and TAP block. Patients were randomly allocated into two groups (n=35 each). Patients were administered intrathecal 2.8 mL of 0.5% hyperbaric bupivacaine. At the end of surgery, an ultrasound-guided bilateral TAP block was administered using 20 mL of 0.25% bupivacaine on each side (total volume made up to 22 mL). Group SD (Spinal Dexmedetomidine group) received 5 µg (0.05 mL) of dexmedetomidine intrathecally and Group TD (TAP Dexmedetomidine group) received 25 µg dexmedetomidine in TAP block. Haemodynamic parameters, postoperative Visual Analogue Scale (VAS) pain score, time to first rescue analgesia, total rescue analgesic consumption in 24 hours, and sedation scores were noted. Data were analysed using an independent samples t-test and a Chi-square test. A p-value of <0.05 was considered statistically significant. Results: Demographic parameters were comparable between the groups (age, weight, American Society of Anaesthesiologists (ASA) status). Postoperative VAS scores at 0 hour were significantly lower in Group SD (0.8±1.5) compared to Group TD (1.9±2.1) (p-value <0.05). The time to first rescue analgesia was significantly prolonged in Group SD (396.0±200.7 minutes) compared to Group TD (195.4±92.4 minutes) (p-value <0.001). The total postoperative rescue analgesic requirement within 24 hours was significantly lower in Group SD (144.3±45 mg) compared to Group TD (182.9±45.3 mg) (p-value=0.001) haemodynamic parameters remained stable in both groups. Conclusion: Intrathecal dexmedetomidine as an adjuvant to spinal anaesthesia provides superior early postoperative analgesia, prolonged duration of analgesia, and reduced postoperative analgesic requirement compared to dexmedetomidine administered in TAP block. Both techniques maintained satisfactory haemodynamic stability with minimal adverse effects.
Netarsudil, a Rho-Associated Protein Kinase (ROCK) inhibitor, is being increasingly used in the management of glaucoma and corneal endothelial disorders. Although conjunctival hyperaemia and corneal verticillata are well-recognised adverse effects, lacrimal drainage abnormalities have rarely been reported. The authors described a 52-year-old male with Fuchs endothelial dystrophy who developed progressive bilateral epiphora and punctal stenosis following initiation of topical Netarsudil 0.02% eye drops. The patient developed worsening watering and redness approximately four months after initiation of therapy. Slit-lamp examination revealed bilateral conjunctival congestion, corneal guttae with stromal oedema and cicatricial narrowing of both upper and lower puncta. Specular microscopy demonstrated reduced endothelial cell density bilaterally, while anterior segment optical coherence tomography showed increased central corneal thickness. Other causes of acquired punctal stenosis including trauma, autoimmune disease, cicatrising conjunctivitis, Stevens-Johnson syndrome and alternative medication-induced aetiologies were excluded clinically. Despite discontinuation of Netarsudil and initiation of preservative-free lubricants, punctal fibrosis persisted, necessitating bilateral punctoplasty with symptomatic improvement on follow-up. The temporal relationship with drug initiation, exclusion of alternate aetiologies and stabilisation after discontinuation supported a probable adverse drug reaction according to World Health Organisation – Uppsala Monitoring Centre (WHO-UMC) causality assessment criteria. The present case highlights a rare but clinically significant adverse effect associated with Netarsudil therapy and emphasises the importance of early recognition and punctal evaluation in patients receiving prolonged ROCK inhibitor therapy.
Introduction: Emotional Intelligence (EI) is a critical attributefor medical professionals, encompassing self-awareness, selfregulation, motivation, empathy, and social skills. Indian medical students face exceptional stress due to intense academic competition, hierarchical structures, and limited mental health resources. Although structured EI interventions have demonstrated promise internationally in reducing burnout and improving clinical performance, systematic EI training remains largely absent from Indian medical curricula. Aim: To explore the perceptions and experiences of Indian medical graduates regarding the application of EI skills in their clinical and academic lives after completing a structured Value Added Course (VAC). Materials and Methods: This qualitative study was conducted at the Department of Psychiatry, Pramukhswami Medical College, Karamsad, affiliated with Shree Krishna Hospital, a tertiary care Institute in Gujarat, India, between September 2024 and April 2025. The study involved medical students who had participated in a three-month VAC titled “Developing Emotional Competencies,” based on Goleman’s EI model. The course addressed self-awareness, self-management, social awareness, and relationship management through interactive learning and reflective activities. The primary inclusion criterion was participation in the VAC on EI. A total of 10 students were eligible, of whom five students participated in the Group Interview (GI). The interview, conducted approximately one year after course completion, was audio-recorded and transcribed. Thematic analysis was performed following Braun and Clarke’s framework to identify patterns across the data. Results: Seven overarching themes emerged: EI in clinical practice, self-awareness management, social awareness and relationships, professional development, stress and burnout management, EI educational programs, and personal benefits. Students demonstrated concrete applications of EI in patient interactions, emphasising empathetic care while maintaining professional boundaries. Self-awareness emerged as foundational to all EI domains. Participants reported enhanced confidence in navigating emotionally charged interactions, improved recognition and management of stress and normalised emotional experiences. Cross-cutting patterns revealed an evolution from theoretical understanding to practical application. Conclusion: Medical students perceive structured EI training as beneficial for fostering emotional awareness, interpersonal sensitivity, and adaptive coping during medical education. Embedding EI within medical curricula may offer a meaningful avenue to support the holistic development and emotional wellbeing of future healthcare professionals.
