Abstract Background and Aims: Prognostication of patients with chest trauma using scoring systems is an effective tool for predicting the morbidity and mortality. This study aimed to assess the predictive and prognostic values of the chest trauma scoring (CTS) system in patients with thoracic trauma. Methods: This prospective observational study was conducted at the Department of General Surgery and Emergency Medicine of a tertiary care teaching hospital. The CTS was calculated using age, pulmonary contusion severity, number of rib fractures, and the presence of bilateral rib fractures. The final CTS range is 2–12. The objective of the present study was to determine the predictive ability of the CTS for morbidity, mortality, and prognostication in patients with thoracic trauma. Results and Discussion: Data were collected for 185 patients. High CTS ≥ 5 was statistically significantly associated with the need for intensive care unit admission, need for inter-coastal drainage insertion, and development of complications (pneumonia, acute respiratory distress syndrome (ARDS), and metabolic complications) and increased the requirement for mechanical ventilation. Patients with CTS ≥5 had significantly higher complication rates: pneumonia (38.2% vs. 2.1%, P < 0.001), ARDS (7.9% vs. 1.0%, P < 0.05), and metabolic complications (10.1% vs. 1.0%, P < 0.05). The overall mortality was 3.8%, with CTS≥ 7 associated with 17.1% mortality compared to 0.7% in CTS <7 patients ( P < 0.001). The CTS demonstrated good predictive performance with a sensitivity/specificity of 83.3%/85.3% for morbidity and 85.7%/83.7% for mortality. Conclusion: This study concludes that a CTS score of 5 or higher is significantly associated with increased morbidity, and a CTS score of 7 or higher is associated with increased mortality. The CTS demonstrated good predictive performance in identifying patients who are likely to develop complications. The CTS can be a useful tool in predicting morbidity, mortality, and prognostication in patients with thoracic trauma and institute early intensive care.
Introduction: Rabies, a zoonotic disease, primarily transmitted through dog bites, with high mortality rates in India, poses a significant public health challenge. Prompt and appropriate management at the primary care level is crucial to reduce mortality. This study aims to develop a checklist to help primary care medical officers manage animal bites effectively and prevent rabies through timely treatment and post-exposure prophylaxis (PEP). Materials and Methods: A comprehensive checklist for managing animal bites was developed and validated in four phases: literature review, checklist development with expert feedback, content validation by public health and clinical experts, and field testing in various healthcare settings. Content validity was assessed using content validity ratio (CVR) to ensure the necessity of items and item-level content validity index (I-CVI), ensuring the checklist’s relevance and clarity. The final checklist, after expert consultation and field testing, was refined for practical use in primary care settings. Results: A comprehensive checklist for managing animal bites, consisting of six domains and 20 items, was developed, and validated. Expert panel feedback (n = 11) confirmed the checklist’s relevance, with a CVR above 0.59, and I-CVI scores ranging from 0.78 to 1.00. Scale-Level CVI for the domains ranged from 0.80 to 1.00, indicating strong content validity. Conclusion: The developed checklist offers a structured approach for medical officers to manage animal bites efficiently, ensuring prompt PEP administration, and improved patient outcomes. Its validated content will play a key role in reducing rabies transmission and related risks.
Psoriasis vulgaris is a chronic inflammatory skin disease that classically presents with well-demarcated, red plaques with silvery scale, commonly involving the scalp, elbows, knees, and presacral region, though any area of skin may be involved, including the palms, soles, nails, and genitalia. Icotrokinra(Icotyde) is an oral interleukin-23 (IL-23) receptor antagonist that blocks the chronic inflammatory cascade and in turn reduces the severity of symptoms. This review outlines the pharmacological profile, clinical efficacy, and safety data of Icotrokinra, including results from a pivotal randomized, placebo-controlled trial that demonstrated significant improvement in Psoriasis Area and Severity Index and IGA scores from baseline in patients with moderate to severe plaque psoriasis. The review also discusses its pharmacokinetics, adverse event profile, and usage considerations in specific populations. Icotrokinra represents a first in class oral IL23-R antagonist peptide treatment option for managing moderate to severe plaque psoriasis.
Exercise-induced rhabdomyolysis and resultant acute kidney injury (AKI) are becoming an important cause of concern. A young male in his 30s reported to the emergency with severe myalgias and red-brownish urine 3 days following strenuous gym training. Laboratory results indicated high creatine phosphokinase and lactate dehydrogenase levels, myoglobinemia, and AKI. While the rhabdomyolysis improved, the azotemia worsened, requiring additional sessions of hemodialysis. Detailed workup for various etiologies of rapidly progressive renal failure, followed by a kidney biopsy, revealed acute interstitial nephritis coexisting with pigment cast nephropathy. He responded well to a short course of steroids and achieved reversibility of his baseline renal functions over the next 2 months.
Background: Caregivers of individuals with chronic mental illness often experience prolonged emotional, psychological, and physical strain, which can lead to significant and persistent sleep disturbances. Poor sleep adversely affects caregivers’ health and caregiving performance, yet it remains an under-addressed aspect in mental health care services. Objective: To examine changes in the sleep quality of caregivers of patients with chronic mental illness, without any intervention, over a 1-month follow-up period, and to explore the influence of demographic and caregiving factors using the Pittsburgh sleep quality index (PSQI). Materials and Methods: This prospective observational study included 100 adult primary caregivers recruited through convenience sampling from a tertiary care mental health facility in India. Demographic data and PSQI scores were collected at baseline and after a 1-month follow-up. No intervention was provided during the study period. Data were analyzed using the Wilcoxon signed-rank test in IBM Statistical Package for the Social Sciences version 26.0. Results: At baseline, 68% of caregivers reported poor sleep quality (PSQI > 5), decreasing slightly to 66% at follow-up. No statistically significant change was found in global PSQI scores (Z = −0.515, P = 0.607). Poor sleep was more prevalent among female, middle-aged, unemployed caregivers and those caring for highly dependent patients. Sleep duration and habitual sleep efficiency were the most affected PSQI components. Conclusion: In the absence of intervention, sleep quality among caregivers of individuals with chronic mental illness remains largely unchanged over a 1-month period. Early identification and tailored psychosocial strategies are essential to mitigate caregiver burden and improve overall health care outcomes.
Introduction: A prescription audit is a systematic review of prescriptions to evaluate the quality of medical care and adherence to standards, such as the World Health Organization (WHO) prescribing indicators. It identifies errors such as omissions and commissions, which can lead to adverse outcomes and irrational drug use. By addressing these issues, audits promote safer, cost-effective, and rational prescribing practices, ultimately improving patient care. Context: Prescription audit with the WHO core criteria. Aims: The aim of the study was to find out prevailing prescription errors and study the prescription pattern and analyze its appropriateness according to the WHO drug prescribing indicators of out-patients in medicine department of MGM Medical College and M.Y. Hospital, Indore. Settings and Design: This study was conducted at Medicine OPD of M.Y. Hospital and Pharmacology Department, MGM Medical College. This was a prospective cross-sectional observational study. Materials and Methods: An observational cross-sectional study was conducted over 15 days in May 2024. A total of 230 prescriptions from medicine outpatient department were analyzed using a structured pro forma to evaluate patient and doctor information, drug details, and prescription legibility. Statistical Analysis Used: Statistical analysis used Microsoft Excel version 2108. Results: Patient information, including name, age, sex, and address, was complete in all prescriptions, but height and weight were missing in all cases. Doctor information was mostly present, with some missing signatures and phone numbers. The average number of drugs per prescription was 3.53. Most drugs were prescribed by generic name (92.97%), and the prevalence of antimicrobials was low (8.26%). Injectable drugs were infrequently used (10 cases/1.74%). Conclusions: The study highlighted good adherence to the WHO guidelines in terms of using generic names and limiting polypharmacy. However, improvements are needed in prescription completeness and documentation of doctor’s contact details. Regular audits and targeted interventions could enhance prescription practices and patient care quality.
Pregabalin, a gabapentinoid frequently prescribed for neuropathic pain, is also increasingly identified as a drug for abuse. There is a rising concern regarding its abuse potential, and a handful of case reports have highlighted the same. We present a case series on pregabalin dependence. In contrast to previous case reports, which focused on patients with a history of illicit drug abuse, we present cases of drug-naive individuals for whom pregabalin was the first substance of abuse. The highlight of the study is that we describe cases of pregabalin intoxication and a rare case of pregabalin withdrawal, which presented as a lethal suicidal attempt in tertiary care settings.
Background: India bears a disproportionate burden of global deaths owing to snakebite, accounting for nearly 50%, yet knowledge and awareness of effective management practices remain critically low. Materials and Methods: A qualitative study, employing Focus Group Discussions (FGDs) and Key Informant Interviews (KIIs) in rural Himachal Pradesh, India, investigated community perceptions, knowledge, and practices surrounding snakebite envenoming. Results: Thematic analysis revealed that the communities employed a dual healthcare strategy for snakebites, blending traditional healing methods, such as herbal remedies and faith-based rituals, with or preceding the use of conventional medical treatments. Awareness efforts by the government healthcare system did not translate into accurate knowledge of snakebite treatment as ineffective practices—such as the use of tourniquets and herbal remedies—remained widespread. Conclusion: The study highlights the need for targeted public healthcare interventions to enhance community education, improve access to appropriate medical care, and facilitate the integration of validated traditional practices within a contemporary healthcare framework, thereby mitigating snakebite-related morbidity and mortality.
Combined pulmonary fibrosis and emphysema (CPFE) is an underdiagnosed condition characterized by upper lobe emphysema and lower lobe fibrosis, most often seen in male smokers. Despite distinct radiologic features, CPFE is frequently overlooked due to symptom overlap with other lung diseases. It presents with preserved lung volumes but markedly reduced diffusing capacity for carbon monoxide, hypoxemia, and exertional desaturation—reflecting the opposing effects of emphysema and fibrosis. Pulmonary hypertension, a common complication, significantly worsens prognosis. At present, there are no specific diagnostic or treatment guidelines for CPFE, and management is generally based on chronic obstructive pulmonary disease and pulmonary fibrosis protocols, which may not address its unique pathophysiology. Increased clinical awareness and further research are needed to define diagnostic criteria and develop targeted therapies. We report a case of CPFE in a patient presenting with cough and exertional dyspnea, illustrating the diagnostic, and therapeutic challenges of this condition.
Isolated penile gangrene is a very rare clinical presentation which should prompt us to look for an underlying pathology. We report a case of a 74-year-old man who presented to us with fatigue. He had an ulcer on the prepuce of his penis, for which he underwent circumcision after 1 week. Following this, he developed a non-healing ulcer on the glans penis a week later, which then progressed to gangrene with pus discharge from the glans penis. Preliminary workup showed severe anemia, leukocytosis, and pus culture grew Acinetobacter baumanii . On treatment with prompt antibiotics, blood transfusions, and a supra pubic catheter, his condition improved symptomatically along with his blood parameters. His peripheral smear showed neutrophilia with a marked shift to the left, suggestive of a leukemoid reaction. The diagnosis of acute monocytic leukemia was confirmed after a bone marrow biopsy. This is a case where penile gangrene was the initial manifestation of an underlying serious hematological malignancy. This case emphasizes the importance of probing into underlying systemic pathologies, such as hematological malignancies, in patients with penile gangrene. It also highlights the necessity for a multi-disciplinary team approach for its diagnosis and management.
Antibody–drug conjugates (ADCs) are considered an important advancement in the field of targeted cancer therapy, integrating monoclonal antibodies with cytotoxic payloads to eliminate cancer cells while reducing damage to healthy cells and tissues. These drugs have evolved significantly since the United States Food and Drug Administration approved gemtuzumab ozogamicin in 2000, utilizing modern linkers and nanotechnology to enhance efficacy and stability. The structure of an ADC consists of an antibody, a linker, and a cytotoxic payload. ADCs use antigen–antibody reactions to internalize and release cytotoxic agents into cancer cells, resulting in cell death. Recent advances in linker development and conjugation chemistry have significantly improved specificity, drug–antibody ratio, and pharmacokinetics of these therapeutic drugs. However, complexities such as drug resistance and cytotoxicity persist. The utilization of artificial intelligence in the field of ADCs has sped up the process of drug development, focusing on enhanced efficacy, potency, toxicity, and stability. Despite a promising future, consistent research study is needed to improve ADC design and efficacy as their application in cancer therapy is diversified. This review explores the structure, mechanism, and utility of ADCs, as well as future challenges and opportunities in cancer medicine.
Background: In India, the majority of construction workers are engaged in the informal sector, often working under unsafe and unhygienic conditions with minimal occupational safety. Limited access to healthcare, poor sanitation, malnutrition driven by poverty, and menstrual irregularities among female workers further exacerbate their health risks. These factors collectively contribute to a high burden of anemia among this vulnerable labor force. Understanding the prevalence and determinants of anemia among them is crucial for targeted interventions and improved worker well-being. Materials and Methods: A cross-sectional study was conducted to estimate the prevalence of anemia among reproductive-age women engaged as laborers of 18–49 years in construction sites. The sample size considered for the study was 147. Hemoglobin levels were measured using a portable hemoglobinometer (HemoCue). Anemia was defined as hemoglobin <12 g/dL. The data were analyzed using the Statistical Package for the Social Sciences statistical software. Results: The prevalence of anemia was 82.99% (122/147). The majority, 73 (49.7%), had mild anemia, while 36 (24.5%) had moderate anemia, and 13 (8.8%) had severe anemia. Younger individuals (<30 years) were more likely to have anemia (adjusted odds ratio [AOR]: 2.14, P < 0.001). Married individuals also showed a higher risk (AOR: 4.85, P < 0.001). Educational status was not associated with increased anemia (AOR: 1.16, P = 0.51). Menstrual irregularities significantly elevated the risk (odds ratio: 3.56, P < 0.001). Fatigue (AOR: 0.71, P = 0.03) and shortness of breath (AOR: 1.76, P = 0.01) were also linked to anemia. Lack of deworming treatment strongly correlates with anemia (OR: 3.38, P < 0.001). Conclusion: Anemia is highly prevalent among reproductive-age women laborers in construction sites, highlighting the need for targeted interventions to address this issue and improve their overall health and productivity.
Abstract Background: Polypharmacy is frequently encountered in ischemic heart disease (IHD), especially in patients with coexisting hypertension and type 2 diabetes mellitus (T2DM). Although multidrug therapy is clinically justified, the risk of potential drug–drug interactions (pDDIs) rises with therapeutic complexity, particularly in older adults. Objective: To evaluate the prevalence of polypharmacy and characterize the patterns and severity of pDDIs in IHD patients with and without cardiometabolic comorbidities in a tertiary care setting. Materials and Methods: This cross-sectional observational study was conducted over 3 months in the General Medicine and Cardiology outpatient departments of a tertiary hospital in Eastern India. One hundred patients with diagnosed IHD were enrolled, including those with isolated IHD, IHD with hypertension, or IHD with hypertension and/or T2DM. Patients with severe hepatic or renal dysfunction were excluded. Prescription data were analyzed for pDDIs using the Medscape Drug Interaction Checker. Statistical analysis was performed with Statistical Package for the Social Sciences v25. Results: The mean age was 57.9 ± 14.5 years; 70% were male. Comorbid hypertension and T2DM were present in 70% of patients, while 6% had isolated IHD. Polypharmacy (≥5 drugs) occurred in 56% of prescriptions, with an average of 6.4 ± 1.2 drugs per patient. Overall, 61% of patients had at least one pDDI. Major interactions occurred in 18% of patients, most commonly aspirin with non-steroidal anti-inflammatory drug, Angiotensin-converting enzyme (ACE) inhibitors with potassium-sparing diuretics, and clopidogrel with proton pump inhibitors. Conclusion: Polypharmacy and clinically important pDDIs are highly prevalent among IHD patients, particularly those with multimorbidity. Incorporating interaction-screening tools, routine medication review, and clinical pharmacist support may improve prescribing safety and optimize outcomes.
Abstract Background: Look-alike and sound-alike (LASA) drugs pose a significant risk to patient safety, contributing to medication errors during prescribing, dispensing, and administration. These errors are preventable but persist globally, particularly in resource-limited healthcare systems. Understanding healthcare professionals’ (HCPs) knowledge, attitude, and practice (KAP) regarding LASA drugs is essential for developing targeted interventions to enhance medication safety. Materials and Methods: A cross-sectional, survey-based study was conducted among 230 HCPs (physicians, nurses, and pharmacists) in eastern India. A structured, validated questionnaire assessed KAP regarding LASA drugs. Descriptive statistics summarized demographic characteristics and KAP scores. Associations between KAP scores and demographic variables were analyzed using chi-square tests. Results: Most participants (84.8%) were aware of LASA drugs, with pharmacists demonstrating higher knowledge scores compared to physicians and nurses ( P < 0.01). While 93.9% acknowledged the need for additional training, only 28.7% had received formal LASA-specific training. Preventive strategies such as Tall Man lettering and barcode scanning were frequently cited, yet their application in daily practice was inconsistent. Approximately 22% reported involvement in LASA-related incidents, with gaps noted in incident reporting and resolution. Conclusion: The study highlights substantial knowledge gaps, mixed attitudes, and inconsistent practices regarding LASA drugs among HCPs. Targeted training, robust reporting mechanisms, and adherence to safety protocols are recommended to mitigate LASA-related errors and enhance patient safety.
Abstract Plexiform schwannoma (PS) is a rare type of schwannoma, accounting for only 5% of all schwannomas, with most cases occurring in the skin and subcutaneous tissue and showing a predilection for the head and neck region, similar to ordinary schwannomas. The diagnosis is confirmed by the histopathological examination. The therapy of choice is surgical excision with biopsy. Tumor recurrence is limited locally without any metastatic potential. Here, we present a case of a 1-year-and-7-month-old male child with a firm lesion in the left anterior chest, which was excised completely, and the biopsy came up as PS.
The purpose of this study is to thoroughly assess how microRNAs (miRNAs) function in valvulogenesis, the process by which heart valves grow, and investigate their potential as treatment targets for valvular disorders. Using terms such as “microRNAs,” “valvulogenesis,” “heart valve development,” and “therapeutic potential,” a comprehensive literature search was carried out using PubMed, Web of Science, and Scopus, with an emphasis on research published up to 2024. Preclinical models, clinical research, and mechanistic understanding of the role of miRNA in the control of valve morphogenesis, extracellular matrix remodeling, and cellular differentiation were given priority in the inclusion criteria. While dysregulated miRNAs are linked to diseases including aortic stenosis and mitral regurgitation, key studies emphasize miRNAs as essential regulators of the valve progenitor cell fate, endothelial-to-mesenchymal transition, and tissue homeostasis. The review addresses issues including species-specific variability and off-target consequences while synthesizing new approaches for miRNA-based treatments, such as delivery methods and biomarker applications. The translational potential of miRNAs to transform preventative and therapeutic strategies for cardiovascular illnesses linked to valves is ultimately highlighted by this study.
Background: Medication use during pregnancy requires caution due to altered pharmacokinetics and possible teratogenic effects. Early antenatal care (ANC) offers a vital opportunity for rational prescribing and preventing unsafe self-medication. However, few Indian studies have systematically explored drug use in early pregnancy. This study assessed prescribing patterns and self-medication practices during the first trimester of pregnancy in a tertiary care setting in Eastern India. Materials and Methods: A cross-sectional study was conducted among 250 pregnant women (≤12 weeks gestation) attending their first ANC visit at Calcutta National Medical College, Kolkata, from October 2024 to March 2025. Data were collected through a structured, interviewer-administered questionnaire. Drugs were classified using the WHO Anatomical Therapeutic Chemical system and United States Food and Drug Administration pregnancy risk categories. Descriptive statistics and multivariate logistic regression were used. Results: All participants were registered for ANC in the first trimester. Prescriptions were reported by 84.8%, mainly iron–folic acid (90%) and tetanus toxoid (84.8%). Only 36% received counseling on deworming; 15.2% had already taken albendazole, mostly before ANC registration. Self-medication was reported by 20%, mostly involving paracetamol, antacids, and herbal remedies. No contraindicated drugs were prescribed. Self-medication was significantly associated with lower education (adjusted odds ratio [AOR] = 3.9; 95% confidence interval [CI]: 1.8–8.5; P = 0.001), rural residence (AOR = 2.6; 95% CI = 1.3–5.3; P = 0.006), and being a housewife (AOR = 2.2; 95% CI = 1.0–4.9; P = 0.045). Conclusion: Despite rational prescribing, self-medication and limited counseling remain challenges. Strengthening ANC-based education is essential.
Posterior reversible encephalopathy syndrome (PRES) is a medical condition that presents with headache, seizures, visual disturbances, and altered mental state. It has a distinctive pattern of vasogenic edema in the subcortical white matter of the brain’s posterior parietal-occipital regions on magnetic resonance imaging. PRES may rarely complicate pregnancy, especially in cases of eclampsia. Here, we report the case of a primigravida woman at 19 weeks of gestation, who presented with headache, high blood pressure (BP), altered sensorium, and generalized seizures. The medical intervention involved seizure control and stabilization of her BP, though she had an intrauterine fetal demise. The patient fortunately had a complete recovery. This case highlights the possible neurological consequences of undetected hypertension in pregnancy resulting in substantial morbidity and mortality. There is a critical need for early identification, monitoring, and management of hypertensive disease in expectant mothers.
The aim of this case report is to highlight the diagnostic challenges and complex presentation of tuberous sclerosis (TS). We have reported the case of a 23-year-old male who presented to the psychiatry outpatient department with the complaint of irritability since 2 years and refusal to go to school since 1 year and subsequently diagnosed as TS. We have briefly described the management of the behavioral symptoms in patients.
