Abstract Pulmonary embolism (PE) is a potentially life-threatening manifestation of venous thromboembolism and the third-leading cause of cardiovascular death worldwide. Its clinical presentation is heterogeneous and often nonspecific, contributing to delayed diagnosis and variable outcomes. Diagnosis relies on clinical probability assessment, D-dimer testing, and selective imaging, while the YEARS algorithm and age-adjusted D-dimer thresholds reduce unnecessary computed tomography pulmonary angiography. Risk stratification integrates hemodynamic status, right ventricular dysfunction, and cardiac biomarkers, and the 2026 American Heart Association (AHA)/American College of Cardiology (ACC) Acute PE Clinical Categories (A–E) provide a contemporary framework for clinical decision-making. Anticoagulation remains the cornerstone of treatment, whereas reperfusion therapies are reserved for high-risk PE and selected patients with clinical deterioration. This review summarizes current evidence on the pathophysiology, diagnosis, risk stratification, and management of acute PE, incorporating recommendations from the 2019 European Society Of Cardiology/European Respiratory Society guideline, the 2026 AHA/ACC/Multisociety guideline, the 2024 NAMS (India) Task Force report, and recent Indian data.
Abstract Background: Polycystic ovary syndrome (PCOS) is a common endocrine disorder and insulin resistance (IR) is central to its pathogenesis. Although metformin is widely used as an insulin sensitizer, gastrointestinal adverse effects may limit adherence. N-acetylcysteine (NAC), having insulin-sensitizing properties, has emerged as a potential alternative, but comparative evidence remains limited. Objective: To compare the efficacy of NAC and metformin, each combined with clomiphene citrate, on IR, hormonal and metabolic profiles, oxidative stress, ovulation, and pregnancy outcomes in infertile women with PCOS. Materials and Methods: In this randomized, single-blind controlled trial, 169 infertile women with PCOS were randomized to receive NAC (600 mg three times daily) or metformin (500 mg three times daily), each combined with clomiphene citrate for 6 months. The primary outcome was change in 2-h postglucose serum insulin. Secondary outcomes included ovulation, clinical pregnancy, hormonal and metabolic parameters, oxidative stress and adverse events. Results: Of 343 women screened, 169 were randomized; 166 completed the study. Both treatments significantly improved glucose metabolism, IR, lipid profile, oxidative stress, and ovulation. Metformin produced greater reductions in Luteinizing hormone, testosterone, and 2-h postglucose insulin than NAC (28.48 vs. 16.64 µIU/mL; P = 0.037). Clinical pregnancy rates were higher with metformin (34.9% vs. 22.9%), although the difference was not statistically significant. No serious adverse events occurred. Conclusions: Both NAC and metformin improved metabolic, hormonal, and reproductive outcomes. Metformin was superior in reducing postprandial IR and hyperandrogenism, whereas NAC may be a safe alternative for women intolerant to metformin. Larger multicenter trials are needed to confirm these findings.
Abstract Background: Dietary behavior plays a crucial role in diabetes management; however, patients’ perceptions and beliefs about common food items often influence adherence. Misconceptions regarding fruits, sweets, and traditional foods remain prevalent in India. The study was planned with an aim of assessing the dietary myths, beliefs, and perceptions regarding common food items among patients with diabetes mellitus attending a tertiary care center in Delhi. Methodology: A cross-sectional study was conducted among 210 patients with diabetes using a structured questionnaire. Proportions were calculated, and associations with demographic variables were analyzed using the Chi-square test. Results: A total of 210 participants were included, with a predominance of older adults and a near-equal gender distribution; most were educated and on oral hypoglycemic therapy. High levels of misconceptions were observed, with 70.9% believing jaggery is safer than sugar and 63.3% considering fruits harmful in diabetes. Awareness was high for traditional foods such as turmeric (85.7%) and ginger (82.4%), but low for newer concepts, such as probiotics (34.3%) and chia seeds (28.1%). Misbeliefs persisted regarding dried fruits, sugar-free products, and the exclusion of rice. Cultural beliefs were prominent, with many participants attributing diabetes to excessive tea consumption or believing that bitter foods can reduce blood glucose. Education level showed a significant association with glycemic index awareness ( P = 0.021), whereas age and gender were not significantly associated. Conclusion: The study highlights a substantial burden of dietary myths and a significant knowledge–practice gap among patients with diabetes. While general awareness exists, it is often fragmented and influenced by cultural beliefs. Targeted dietary education is essential for improving diabetes management.
Abstract Double inlet left ventricle (DILV) is a rare and complex cyanotic congenital heart disease (CCHD), characterized by chronic hypoxia resulting from the admixture of oxygenated and deoxygenated blood. In response, patients often develop compensatory secondary polycythemia, which increases blood viscosity. While polycythemia is known to elevate the risk of thromboembolic events such as stroke, overt hyperviscosity syndrome is uncommon. Classically, hyperviscosity syndrome has been associated with monoclonal gammopathies, less frequently with primary polycythemia, and only rarely with secondary polycythemia. We report the case of a 19-year-old male with DILV who was relatively asymptomatic till few months back, presented with worsening cyanosis, progressive dyspnea, edema, and symptoms of hyperviscosity, including holocranial headaches and visual disturbances. Investigations revealed an exceptionally elevated hematocrit level of 84.3%, which has not been reported yet. Despite such extreme erythrocytosis, the patient did not demonstrate any focal neurological deficits or cerebrovascular sequelae, highlighting a compensated erythrocytosis state. He was managed with serial phlebotomies, intravenous fluids, and anticoagulation, leading to symptomatic relief. Reporting such cases is critical, as they not only emphasize the rare natural survival of uncorrected complex congenital heart diseases into adulthood but also underscore the clinical challenge of balancing oxygen delivery and viscosity-related complications. Early recognition and tailored management are essential to prevent life-threatening consequences. Documenting such presentations contributes to the growing body of evidence needed to optimize treatment protocols and long-term outcomes in patients with uncorrected or palliated CCHD.
Abstract Background: Tobacco has been regarded as the most commonly and widely used psychoactive substance. Nicotine in tobacco is primarily responsible for dependence. In India, as per Global Adult Tobacco Survey 2, almost 28.6% of the population uses tobacco. As per the World Health Organization fact sheet 2023, more than 8 million people die each year because of tobacco. Higher consumption of tobacco has been reported among industrial workers. Objective: This study aimed to assess the pattern, prevalence, and severity of nicotine use among industrial employees. The study also explored the association between sociodemographic profile and severity of nicotine use. Materials and Methods: This cross-sectional observational study was carried out in a tertiary care hospital. A total of 2500 participants were recruited, including both patients and their caregivers, selected by a consecutive sampling method. A semi-structured pro forma for sociodemographic details and the Fagerström Test for Nicotine Dependence to assess the level of dependence were used. Descriptive statistics were used for data analysis. Results: A large portion of participants exhibited high (40.26%) or very high (21.80%) dependence. Participants who started consumption at an earlier age (≤20 years) had higher dependence. Similarly, male, married participants, illiterate individuals, and individuals with comparatively higher personal and family income reported to have more severe dependence. Conclusion: Targeted public health interventions must address these sociodemographic such as like age, gender, marital status, education, and income to effectively reduce tobacco addiction. Future efforts to reduce nicotine dependence should focus on the most vulnerable groups, particularly younger people and those with lower educational and higher income levels.
Abstract Introduction: Diabetic nephropathy (DN), a leading cause of end-stage renal disease in patients with type 2 diabetes mellitus (T2DM), is characterized by progressive renal impairment and chronic inflammation. Identifying simple, reliable, and cost-effective biomarkers for early detection and monitoring of DN is essential. This study investigates the utility of neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) as inflammatory markers in DN. Materials and Methods: A cross-sectional, case–control study was conducted at a tertiary care hospital in Lucknow over 24 months. A total of 86 T2DM patients were enrolled, with 43 patients having DN (cases) and 43 without DN (controls), classified based on urinary albumin-to-creatinine ratio as per KDIGO 2012 guidelines. Clinical, anthropometric, and laboratory parameters were assessed, and NLR and PLR were calculated from complete blood counts. Statistical analysis included t -tests, Pearson’s correlation, and receiver operating characteristic (ROC) curve analysis. Results: NLR and PLR were significantly elevated in patients with DN (NLR: 7.16 ± 7.24; PLR: 11.65 ± 6.33) compared to controls (NLR: 3.44 ± 3.15; PLR: 8.45 ± 6.70) with P = 0.003 and 0.026, respectively. ROC analysis showed NLR had greater diagnostic accuracy (area under the ROC [AUROC] = 0.759) than PLR (AUROC = 0.685). Patients with DN also exhibited higher body mass index, poorer glycemic control (elevated FBS and PPBS), lower hemoglobin levels, and higher urea and creatinine values. Conclusion: NLR and PLR are significantly associated with DN and may serve as accessible, cost-effective biomarkers for its early detection. Among them, NLR demonstrated superior diagnostic performance. Further prospective studies are needed to validate their clinical application and define standardized cutoff values.
Abstract Background: Pranayama, a yogic breathing technique, has been proposed as a non-pharmacological intervention capable of modulating autonomic function; however, evidence in young, healthy populations remains limited. Objective: The objective of the study is to evaluate the effects of a 12-week structured pranayama intervention on anthropometric parameters (weight, body mass index) and cardiovascular parameters (heart rate, systolic blood pressure [SBP] and diastolic blood pressure [DBP]) among undergraduate medical students. Methods: A prospective pre–post observational study was conducted among 60 undergraduate medical students aged 18–21 years in a tertiary care teaching institution in Kerala, India. Participants underwent supervised pranayama practice (20–45 min/day, 6 days/week) for 12 weeks, including Kapalabhati, Anulom Vilom, Bhastrika, and Bhramari techniques. Anthropometric and cardiovascular parameters were measured at baseline and post-intervention under standardized conditions. Data were analyzed using paired t -tests, with P < 0.05 considered statistically significant. Results: Following the intervention, a significant reduction was observed in cardiovascular parameters. Mean heart rate decreased from 74.50 ± 6.21 to 72.17 ± 6.28 beats/min ( P < 0.0001). SBP declined from 119.87 ± 9.29 to 115.50 ± 11.14 mmHg, and DBP from 72.90 ± 7.08 to 68.97 ± 6.54 mmHg (both P < 0.0001). Anthropometric parameters showed modest reductions; however, these were statistically significant only among male participants, while remaining non-significant in females. Conclusion: Twelve weeks of pranayama practice significantly improves cardiovascular parameters, likely through enhanced parasympathetic activity and reduced sympathetic tone. While short-term effects on anthropometric measures are limited, pranayama represents a simple, safe, and scalable intervention for early cardiovascular risk reduction in young adults.
Effective postoperative pain control is crucial for optimizing recovery and improving the patient outcomes following arthroplasty. Advances in multimodal analgesia, regional anesthesia, and systemic adjuvants have significantly reduced opioid dependence while enhancing comfort and early mobilization. Techniques such as adductor canal and infiltration between the popliteal artery and the capsule of the posterior knee blocks, local infiltration analgesia, and the use of agents like dexmedetomidine, gabapentinoids, and lidocaine have improved pain relief and functional outcomes. Emerging innovations – such as liposomal bupivacaine, cryoneurolysis, and pharmacogenomic-guided personalized analgesia – represent the next frontier in achieving sustained, patient-centered pain control. Despite these developments, challenges remain in terms of cost, accessibility, and standardization. Future strategies should focus on integrating individualized, evidence-based, and technologically supported pain management within enhanced recovery pathways.
Endometriosis in adolescents is an underrecognized yet impactful condition that often presents with nonspecific symptoms such as dysmenorrhea and chronic pelvic pain. Diagnostic delays remain a major barrier, with the current gold standard of laparoscopy being invasive and less acceptable in younger patients. In recent years, noninvasive biomarkers – including circulating glycoproteins, inflammatory cytokines, genetic and epigenetic regulators, proteomic and metabolomic profiles, and urinary, salivary, and menstrual fluid markers – have gained attention for their potential role in early detection. Imaging modalities such as ultrasound and magnetic resonance imaging are essential adjuncts, particularly when integrated with biomarker assays, to improve diagnostic accuracy. Despite encouraging findings, variability across populations, modest sensitivity and specificity, and ethical considerations in adolescent testing remain challenges. Future directions emphasize multi-omics integration, artificial intelligence-based diagnostic algorithms, and longitudinal adolescent cohorts to validate findings and enable translation into clinical practice. Together, these advances hold promise for earlier, safer, and more reliable diagnosis, ultimately improving long-term outcomes for adolescents with endometriosis.
The purpose of this article is to assess the safety and effectiveness of cytokine-targeted treatments for inflammatory cardiomyopathy and myocarditis. Clinical trials, case studies, and observational studies that have been published in the past 10 years and particularly look into the use of cytokine inhibitors, such as small molecule inhibitors and monoclonal antibodies, in patients with myocarditis or inflammatory cardiomyopathy are included in the inclusion criteria. Investigations with insufficient cytokine targeting data, non-human investigations, and reviews without original data are among the exclusion criteria. The analysis comes to the conclusion that cytokine-targeted treatments have the potential to significantly enhance clinical outcomes in a number of studies by modifying the inflammatory response in myocarditis and inflammatory cardiomyopathy. However, cautious patient selection and monitoring are required due to the possibility of side effects, including infections and autoimmune problems. To maximize patient outcomes, future research should concentrate on finding biomarkers to forecast drug response and creating individualized treatment plans.
An elderly man presented with complaints of postprandial abdominal pain of a month duration. His contrast-enhanced computed tomography (CT) of the abdomen showed spontaneous isolated superior mesenteric artery dissection (SISMAD). Initially, there was no indication for surgery; hence, the patient was managed conservatively and kept under close follow-up. About 3 weeks following diagnosis, the patient presented with recurrent abdominal pain, distension, vomiting, and food intolerance. A follow-up CT scan of the abdomen revealed an additional finding of dilated jejunal loops with reduced enhancement. In view of recurrent subacute intestinal obstruction (SAIO) that required repeated hospital admission, the patient was planned for diagnostic laparoscopy. Intraoperatively, a strictured segment of jejunum was resected, and a side-to-side bowel anastomosis was performed. In the absence of guidelines for the management of SISMAD, we found that recurrent SAIO was a symptom of bowel stricture that required surgical intervention.
Background:Stroke remains a leading cause of morbidity and mortality worldwide, with acute hemorrhagic stroke (AHS) carrying a high risk of complications such as dysphagia. Swallowing dysfunction occurs early after stroke and predisposes to aspiration pneumonia, malnutrition, and poor outcomes. Despite its clinical importance, dysphagia in AHS is underexplored compared to ischemic stroke, highlighting the need for standardized bedside screening. Aims and Objectives:The present study aimed to estimate the prevalence of dysphagia in AHS patients and evaluate the applicability of the Gugging Swallowing Screen (GUSS) for early detection of dysphagia. Materials and Methods:This prospective cross-sectional study (May 2023-May 2025) at Jawaharlal Nehru Medical College, Aligarh, included 166 AHS patients admitted within 72 h of the incident. Excluding preexisting dysphagia and ischemic stroke, participants underwent the GUSS assessment. The study participants were divided into 83 participants each, and GUSS was applied to only group A. Statistical analysis evaluated associations between dysphagia, aspiration pneumonia, hospital stay, and mortality between these two groups to determine the clinical relevance of GUSS in early detection. Results:Overall, dysphagia prevalence was 65.6% among the screened patients. Aspiration pneumonia was significantly higher among those with low GUSS scores (P < 0.001). Patients with impaired swallowing had longer hospital stays, and mortality was markedly higher in those with poor swallowing function (34.9% vs. 18.1%, P = 0.014). GUSS effectively stratified aspiration risk and predicted adverse outcomes. Conclusion:Dysphagia is common in AHS, increasing the risks of pneumonia, prolonged hospitalization, and mortality. GUSS enables early detection and timely intervention, improving outcomes. Routine integration of GUSS into stroke care protocols is strongly recommended.
Introduction:Rabies is a universally fatal yet preventable disease, posing a significant public health challenge, particularly in regions with high animal prevalence. Data on dog bites and rabies awareness in Bhopal city are limited. This study was conducted to assess the knowledge, attitudes, and practices regarding rabies among patients at the Urban Health Training Center (UHTC) of Chirayu Medical College and Hospital, Bhopal.Materials and Methods:This cross-sectional study included 150 adults attending the outpatient department of the UHTC from March to May 2025. Data were collected using a structured, pretested questionnaire after obtaining informed consent. Data were sorted, compiled, and analyzed using MS excel. Data were presented in tabular and graphical forms and frequency and percentages were calculated.Results:Among the 150 participants, 43.3% had heard of rabies, 60.6% knew about its transmission through bites or scratches, and 64.6% understood it as fatal. Approximately 67.3% knew about postexposure prophylaxis and 74% indicated they would seek hospital care after an animal bite. However, only 43.3% supported sterilization to control stray dog populations. While 70% endorsed pet vaccination, only 15.3% vaccinated their pets annually showcasing a clear gap between awareness and practices.Conclusion:The study reveals significant gaps in rabies-related knowledge and practices among the population. Targeted educational initiatives, improved access to vaccination, and collaborative public health efforts with local administration are essential to reduce the incidence of rabies.
Background: "Various electrolyte imbalances are associated with chronic liver disease (CLD), and disease severity and outcomes may be influenced by them. These disturbances may be identified for risk stratification and targeted management. Thus, our current analysis aims to assess the distribution of age, gender, and etiology in CLD patients and to evaluate serum sodium, potassium, and calcium levels in relation to disease severity, complications, and outcomes". Materials and Methods: "A total of 121 CLD patients were evaluated for demographic characteristics, etiological factors, electrolyte levels, disease severity (Child-Pugh classification), complications, and clinical outcomes. Statistical analysis was performed to determine associations between variables". Results: "The majority of patients were >60 years (40.49%) with a male predominance (57.02%). Hepatitis B was the most common etiology (31.40%), followed by alcoholic liver disease (28.09%) and hepatitis C (24.79%). Hyponatremia (<= 130 meq/L) was observed in 48.76% of cases, while most patients had potassium and calcium within normal limits. Nearly half were Child-Pugh Class B, followed by Class C. However, sodium levels were significantly associated with outcome (P = 0.019874), with higher mortality among those with sodium <= 130 meq/L. Potassium and calcium showed nonsignificant correlation with outcome. Age was not significantly associated with mortality, but gender showed a significant relationship (P = 0.017268), with males having higher mortality". Conclusion: "Hyponatremia is a common and clinically significant predictor of poor outcomes in CLD, whereas potassium and calcium levels have limited prognostic value. Elderly males and those with low sodium require closer monitoring and aggressive management to improve survival".
Introduction:People's purchasing capacity has been increasing in recent years due to greater accessibility enabled by smartphones and mobile applications. But at the same time, it becomes a routine activity and an uncontrollable means to buy things and leads to a disorder called compulsive buying disorder (CBD). The objectives of the present study were to estimate the prevalence of CBDs and to identify the risk factors associated with it among undergraduate medical students.Materials and Methods:A cross-sectional study was conducted among the representative sample of 293 undergraduate medical students from Phase I MBBS to Phase III MBBS Part 2 in a private medical college in Karnataka. A pretested semi-structured questionnaire was used to collect sociodemographic information, and the Richmond Compulsive Buying scale was used to measure CBD prevalence. Bivariate analysis was conducted to identify the risk factors associated with CBD.Results:Among 293 study participants, 60 (20.3%) have CBD. Students staying away from their parents, students spending money not accounted for by their parents, year of study, pocket money provided by parents per month, being tempted by offers or deals, habit of saving money, and students having a savings account or a recurring account, were found to be significantly associated with CBD.Conclusions:This study identified social media, poor saving habits, and other factors as risk factors related to CBD. The goal is to recognize these risk factors and address CBD in its early stages to prevent long-term financial and psychological consequences. In medical colleges, awareness programs and mental health support systems should be integrated, and parents should be counseled to avoid CBD in children.
