More than 80% of women experience hot flashes (HFls) during menopause. These are defined by transient sensations of heat, sweating, flushing, anxiety, and chills lasting for 1–5 minutes. HFls can cause considerable distress, especially when severe and frequent, thus affecting a healthy menopause. This review discusses the epidemiology, pathophysiology, clinical features, and management of menopausal HFls. Epidemiological data indicate that HFls affect 85% of women globally, with varying prevalence across regions. The exact pathophysiology remains unclear but involves dysfunction of the hypothalamic thermoregulatory center, influenced by estrogen deficiency, serotonergic and noradrenergic mechanisms, neurokinin B (NKB) pathways, and calcitonin gene-related peptide (CGRP) activity. Clinical presentation typically includes transient heat sensations, predominantly affecting the face and upper body, with associated sweating, chills, and sleep disturbances. Management depends on severity, with lifestyle modifications and cognitive behavioral therapy recommended for mild symptoms. Hormone replacement therapy (HRT) remains the first-line treatment for moderate to severe HFls, with careful risk assessment. Nonhormonal options, such as selective serotonin (SRT)/norepinephrine (NE) reuptake inhibitors, gabapentin, and emerging therapies, such as neurokinin 3 receptor (NK3R) antagonists, offer alternatives for women unsuitable for HRT. In this review, we will discuss a structured approach to the diagnosis and management of HFls to alleviate symptoms and improve the quality of life in menopausal women.
Visual alterations in a migraine headache are examined by integrating migraine-related pathology theories with patient-reported vision-related symptoms of a migraine. Monitoring the visual symptoms in a migraine attack is extremely significant because patients with migraine with aura (MwA) have sophisticated visual symptoms—scintillating scotomas, zigzag (fortification) patterns, blurred vision, photophobia, and transient loss of vision. Medical studies about cortical hyperexcitability in the visual cortex area have established that these symptoms appear in such conditions. The research examines the influence of migraine on visual processing of image recognition of pattern, color, and faces and examines the influence of these processes on the everyday lives of people. All these symptoms create a great impact on day-to-day functioning; hence, proper evaluation is necessary because these symptoms are usually misattributed to other neurological disorders. For the proper management of migraine, there needs to be a proper migraine diagnosis. The most critical treatments for migraine are acute medications in combination with calcitonin gene-related peptide (CGRP) migraine preventive drugs, and other novel treatment options. Migraine management involves comprehending the visual symptoms of the disorder because patients' quality of life directly relies on migraine management.
Influence and persuasion are powerful communication skills that shape human thinking and behavior. While influence is a gradual process that builds trust and long-term change, persuasion achieves specific outcomes through logical reasoning and emotional appeal. In healthcare, these skills are far more than “soft” skills; they are critical in guiding patient decisions, improving adherence to treatment, and fostering effective teamwork. Influence in clinical practice stems from professional expertise, emotional presence, positional power, and nonverbal communication, which together build credibility and long-lasting trust. Persuasion, in contrast, is action-oriented and relies on principles such as reciprocity, authority, liking, social proof, commitment, and scarcity to motivate timely health decisions. This manuscript explains these concepts through a hypothetical case scenario set in a busy emergency department. The scenario demonstrates how healthcare professionals can apply both influence and persuasion to manage clinical chaos, de-escalate conflicts, and encourage patients and families toward informed choices. It also shows how these skills extend to teamwork by shaping culture, creating shared practices, and building an environment of respect and collaboration. Thus, influence and persuasion are indispensable for modern healthcare delivery. When combined with empathy, clarity, and professional expertise, they not only enhance patient outcomes but also strengthen trust within teams. Cultivating these skills through deliberate training and practice can significantly improve both clinical care and organizational culture.
Background and objective: Postoperative pain after upper limb fracture fixation surgeries delays recovery and increases healthcare costs. Transdermal diclofenac and ketoprofen patches provide sustained, noninvasive analgesia but have not been adequately compared. This study aimed to evaluate the efficacy, tolerability, and cost-effectiveness of diclofenac 100 mg vs ketoprofen 20 mg transdermal patches (TDPs) for postoperative pain management. Methods: In this prospective, randomized, open-label study, 70 adult patients undergoing upper limb fracture fixation were assigned to group D (diclofenac 100 mg, n = 35) and group K (ketoprofen 20 mg, n = 35). The primary objective was to compare analgesic efficacy; secondary objectives included tolerability and cost-effectiveness. Patches were applied preoperatively. Pain was assessed using the verbal rating scale (VRS) and numerical rating scale (NRS) at 0, 4, 8, 12, and 24 hours. Rescue analgesic requirements and adverse events were monitored. Cost-effectiveness analysis (CEA) was based on treatment cost and necessity of rescue analgesics. Results: Group K showed lower 24-hour overall pain scores, with significantly lower scores at 4 hours postoperatively (VRS: mean difference = 0.46, p = 0.013; NRS: mean difference = 0.77, p = 0.026) and required fewer rescue doses (mean difference = 0.20, p = 0.043). No adverse events occurred. CEA showed that group K saved Rs. 54.51 per patient and incremental cost-effectiveness ratio was negative (ICER = −Rs. 272.5/effect), indicating cost savings with greater efficacy. Conclusion: Ketoprofen 20 mg patches provided better analgesia and greater cost-effectiveness than diclofenac 100 mg patches. Both were well tolerated.
Background and aims: Patient satisfaction is a key indicator of health care quality, particularly in emergency departments (EDs), where overcrowding, limited resources, and time pressures challenge service delivery. Limited evidence exists from low- and middle-income countries (LMICs), including India, despite their unique health system constraints. We conducted the study to evaluate patient satisfaction with health care workers' communication, behavior, and waiting times in the ED of a tertiary care center in Northern India. Methods: We conducted a retrospective observational study in the Emergency Medical Outpatient Department (EMOPD) observation unit of a tertiary center between March 1 and April 15, 2023. Records of patients who were conscious, oriented, and able to provide feedback were included. The feedback forms were administered at discharge and completed either directly by patients or, when patients were unable, by their primary caregivers. Data were extracted from a structured, multilingual, expert-validated questionnaire comprising 33 items covering communication, behavior, and waiting times. Responses were analyzed using descriptive and bivariate statistics. Results: A total of 207 patients were included (median age 48 years; 66% male). Physicians and nurses received the highest ratings for communication, with most patients acknowledging clarity of speech, attentiveness, and confidence during care. Laboratory staff and particularly security personnel were rated lower. Waiting times were generally short for physician consultation, laboratory services, and electrocardiography, with most patients seen within 15 minutes. Radiology services recorded longer delays, with many patients waiting up to 1 hour. No significant differences were observed by age or gender. Conclusion: While physicians and nurses largely met patient expectations for communication, gaps were evident in nonclinical staff behavior and radiology waiting times. Targeted communication training, workflow optimization, and systemic reforms are needed to strengthen patient-centered emergency care in LMIC settings.
Procedural sedation has emerged as a cornerstone of modern anesthesia practice, particularly with the global shift toward minimally invasive diagnostics and therapies. Unlike general anesthesia (GA), which induces complete unconsciousness and requires airway instrumentation, procedural sedation provides anxiolysis, analgesia, and amnesia while preserving spontaneous ventilation and protective airway reflexes. This balance allows safe and efficient performance of endoscopic, radiological, dental, ENT, and ophthalmologic interventions in outpatient and inpatient settings. A narrative review of PubMed and Scopus databases was conducted for English-language studies published between 2013 and 2025, including randomized trials, observational studies, systematic reviews, and meta-analyses involving adults undergoing minimally invasive procedures. Key outcomes assessed included safety, efficacy, recovery, and economic costs. Special attention was given to pharmacological advances, such as propofol, ketamine, dexmedetomidine, and remimazolam, and to high-risk populations, including elderly individuals, patients with obesity, and those with obstructive sleep apnea. Across multiple procedural domains, procedural sedation demonstrated comparable procedural success to GA, with consistently shorter recovery times, reduced ICU utilization, and lower overall costs; reported reductions in hospital length of stay ranged from same-day discharge to 2–3 days depending on procedure type. Recovery advantages include earlier mobilization, reduced postoperative nausea, and fewer delirium events, particularly in elderly patients. Newer agents, notably remimazolam and dexmedetomidine, offer improved cardiorespiratory stability, expanding the safety profile for vulnerable groups. In conclusion, with appropriate patient selection and monitoring, sedation for minimally invasive procedures is safe, effective, and resource-conscious. With proper monitoring, drug selection, and structured protocols, it represents a modern alternative to GA that enhances perioperative safety, accelerates recovery, and optimizes healthcare efficiency.
Background and aims: Determining sex from skeletal remains is a critical component of forensic anthropology and medicolegal investigations. The mandible, due to its durability and sexually dimorphic features, serves as a key bone in sex determination when other skeletal elements are absent. This study aims to analyze various morphological and morphometric parameters of the human mandible to establish reliable criteria for sex determination in a North Indian population. Materials and methods: A cross-sectional, observational study was conducted on 110 dry adult human mandibles (55 males and 55 females) of known sex. A total of 22 parameters (14 morphometric and 8 morphological) were measured using digital vernier calipers, mandibulometer, and protractor. Interobserver and intra-observer variability were assessed for reliability. Data were statistically analyzed using SPSS 26.0. Student's t-test, Chi-squared test, Pearson correlation, and Discriminant Function Analysis (DFA) were employed to determine sex-related differences and predictability. Results: Significant sexual dimorphism was observed in multiple parameters. Morphometric variables such as bigonial breadth, bicondylar breadth, mandibular body height, and ramus height were consistently higher in males (p < 0.05). Morphological features like chin shape, gonial flare, muscular markings, and mandibular robustness showed clear sex differences. DFA revealed that bigonial breadth, ramus height, and chin shape together provided the highest accuracy (93.6%) in sex determination. Conclusion: The study validates the role of the mandible as a reliable bone for sex determination. A combination of selected morphometric and morphological parameters enhances the accuracy of sex prediction in forensic and anthropological applications.
