Hypokalemia with hypertension and metabolic alkalosis is most often caused by renin–aldosterone disorders, but rarely cortisol excess from ectopic adrenocorticotropic hormone (ACTH) production may be a causative factor. We report the case of a 36-year-old male presenting with persistent severe hypokalemia, in whom systematic evaluation revealed ectopic ACTH-dependent Cushing’s syndrome from a pulmonary carcinoid tumor. The case highlights the importance of considering EAS in refractory hypokalemia to enable early and potentially curative management.
Objectives: The study aimed to evaluate the accuracy of the aspartate aminotransferase-to-platelet ratio index (APRI) and fibrosis-4 (FIB-4) scores in identifying liver fibrosis by comparing their diagnostic performance with transient elastography (FibroScan) in patients with chronic hepatitis B (HBV) and hepatitis C (HCV). Materials and Methods: An observational cohort study was conducted in the Department of Medicine at a tertiary care hospital in Haryana, India. Adults (≥18 years) with confirmed HBV or HCV infection were enrolled after serological confirmation and viral deoxyribonucleic acid/ribonucleic acid quantification. APRI and FIB-4 scores were calculated using biochemical and hematologic parameters, with cutoff values of ≥2 and ≥3.25, respectively, indicating advanced fibrosis. Fibrosis staging was performed using FibroScan elastography based on the METAVIR scoring system. Data were analyzed using Statistical Package for the Social Sciences version 25, and a P value ≤ 0.05 was considered statistically significant. Results: A total of 151 patients (mean age, 43.93 ± 13.57 years; 70.2% male) were analyzed. The mean liver stiffness was 10.84 ± 4.69 kPa. Both APRI and FIB-4 values increased progressively with advancing fibrosis (P = 0.001). Receiver operating characteristic analysis revealed an area under the curve of 0.908 (P < 0.001) for APRI and 0.838 (P < 0.001) for FIB-4. At optimized thresholds, APRI (cutoff = 0.7) demonstrated a sensitivity of 73.6% and a specificity of 87.6%, whereas FIB-4 (cutoff = 1.65) showed a sensitivity of 81.6% and a specificity of 88.7%. Both markers exhibited high negative predictive values (>93%). Conclusion: APRI and FIB-4 are reliable, inexpensive, noninvasive tools strongly correlating with FibroScan for the evaluation of liver fibrosis in patients with chronic HBV and HCV. APRI shows higher diagnostic accuracy, while FIB-4 shows greater sensitivity, making them especially valuable in resource-limited settings lacking elastography access.
Introduction: This study compares the effectiveness of flipped classroom (FCR) teaching and didactic lectures, assessing both educational effectiveness and practical feasibility, and perceptions toward teaching–learning process. Materials and Methods: Twenty-five students of Phase 3 Part II MBBS, allotted in a tutorial group, participated in the study. Four core competency topics of Obstetrics and Gynecology were taught. Of these, two topics were taught by didactic lectures, and the other two topics by the FCR method. In the FCR method, after conducting a pre-test, students were provided with pre-read materials of the concerned topic 2 days before the class. In both methods, pre- and post-test scores for each topic were recorded, and feedback was collected from the students. For comparison of pre- and post-test marks paired t-test was used. Results: There were statistically significant improvements in the mean marks of post-tests compared with pre-tests in both teaching methods. Mean post-test marks were higher in the FCR method (6.94) compared with the didactic lecture method (5.98). On further comparison of post-test marks of both the teaching methods, the result was found to be statistically significant (P < 0.05). On analysis of the feedback responses obtained from 25 students, it was observed that 72% learnt better by the FCR method, whereas only 28% learnt better by traditional didactic lectures. Conclusion: Test marks analysis in the present study demonstrated that better learning occurred in the FCR method than traditional didactic lecture methodology. The majority of the students also found the FCR method more interactive and beneficial in learning.
Background: Hypothyroidism is a frequently under-recognized late complication of radiotherapy (RT) in head and neck cancers. Its insidious onset and vague symptoms often delay diagnosis, affecting long-term quality of life. This study aimed to assess the incidence, timing, and severity of thyroid dysfunction following external beam radiotherapy (EBRT), and to identify correlations with clinical and treatment-related variables. Materials and Methods: A retrospective observational study was conducted on patients with head and neck malignancies treated with curative-intent EBRT using standard fractionation. Patients with preexisting thyroid disease or follow-up <6 months were excluded from the study. Thyroid function was assessed using serum thyroid-stimulating hormone (TSH) levels. Subclinical and overt hypothyroidism were defined by standard lab criteria. Associations with age, sex, radiation field, and dose distribution were analyzed. Results: Among 135 patients, 47 (35%) developed post-RT hypothyroidism. Subclinical cases made up 30% (n = 41), whereas 6% (n = 8) had overt hypothyroidism requiring treatment. Median time to TSH elevation was 8.2 months (range: 6–18 months). Higher incidence was seen in patients aged >50 years, females, and those receiving bilateral neck RT. A positive but nonsignificant correlation (r = 0.28) was observed between radiation dose to lower cervical regions and TSH levels. Conclusion: Hypothyroidism is a common sequela of head and neck RT, often subclinical. Routine TSH monitoring starting at 6 months post-RT and annually thereafter is advised, particularly for older patients and those receiving bilateral neck irradiation. Early detection and treatment can improve survivorship and long-term quality of life.
Background: Human papillomavirus (HPV) is a major causative agent of cervical cancer, particularly in resource-limited settings. Geographic information system (GIS) technology can improve vaccination strategies by identifying high-risk areas and optimizing resource allocation. Objectives: This study aimed to use GIS to map high-prevalence areas, identify vulnerable populations, and enhance HPV vaccination coverage in rural India. Materials and Methods: A cross-sectional study was conducted in Sangra Gram Panchayat, Sainthia Block, Birbhum District. Primary and secondary data, including Global Positioning System (GPS)-based household surveys and Census of India (2011) demographic data, were analyzed using GIS (QGIS 3.22.10) for mapping population density, literacy rates, sanitation, and vaccination coverage. Results: A total of 467 students were vaccinated across two phases, while 63 dropped out after the first dose. GIS mapping revealed correlations between poor sanitation, low literacy, and vaccination gaps. Conclusion: GIS enhances public health interventions by improving vaccination planning and monitoring. Integrating GIS into immunization programs can optimize healthcare resource allocation in rural settings.
Context: Time management skills (TMS) are essential for medical students to cope with the intensive demands of the MBBS curriculum. While prior studies often examined academic motivation, anxiety, and procrastination in isolation, there is limited evidence on how these factors collectively shape TMS. Aims: This study aimed to assess the TMS of MBBS students and analyze the influence of academic motivation, anxiety, and procrastination. Settings and Design: This cross-sectional study was conducted among 395 MBBS students of a tertiary care hospital in Kolkata. Materials and Methods: The 29-item structured, self-administered questionnaire assessed TMS, procrastination, academic motivation, and anxiety. Statistical Analysis Used: Data were analyzed using IBM Statistical Package for the Social Sciences Statistics version 26. Descriptive statistics, Pearson’s correlation, and multiple regression were used to determine relationships and predictors. Results: Among participants, 80.76% exhibited moderate TMS, 11.65% poor TMS, and only 7.59% good TMS. Procrastination showed a significant negative correlation with TMS (r = –0.572), whereas academic motivation demonstrated a positive correlation (r = 0.479). Anxiety had a weaker but significant negative correlation (r = –0.313). Regression analysis revealed procrastination (β = –0.345, P < 0.001) as the strongest negative predictor of TMS, whereas academic motivation positively predicted TMS (β = 0.323, P < 0.001). Collectively, these variables explained 41.7% of the variance in TMS. Conclusions: The study underscores the multifactorial nature of TMS among medical students, with procrastination and anxiety undermining, and academic motivation enhancing effective time use. Most students demonstrated moderate TMS, reflecting challenges in long-term planning despite awareness of prioritization.
Background and Objectives: Cervical cancer screening programs have significantly reduced the incidence and mortality associated with cervical carcinoma. However, the onset of the COVID-19 pandemic led to the abrupt suspension of routine healthcare services, resulting in delayed diagnoses and the emergence of advanced cervical lesions. Additionally, widespread psychological distress, stemming from uncertainty, social restrictions, and bereavement, further influenced healthcare-seeking behavior. This study aimed to evaluate the impact of the COVID-19 pandemic on cervical screening rates, patterns of abnormal cytology, and the psychological status of women attending a tertiary care center. Materials and Methods: An observational study was conducted among women attending the Gynecology Outpatient Department of our institute. Clinical, demographic, and cytological parameters were compared between the pre-pandemic (January 2019–February 2020) and pandemic (April 2020–May 2021) periods. The psychological status was assessed using a structured questionnaire-based Patient Fear Score (PFS) designed to evaluate anxiety and pandemic-related distress. Results: The mean age of presentation increased from 36.5 ± 5 years in the pre-pandemic period to 42.6 ± 10 years during the pandemic. Cervical smear submissions declined by 31% during the pandemic, accompanied by an 11.4% increase in abnormal epithelial lesions. High-grade lesions, including high-grade squamous intraepithelial lesion and squamous cell carcinoma, were proportionately higher in the pandemic period. Psychological assessment revealed that 83% of women had elevated PFS scores, indicating significant fear and anxiety, which was strongly associated with delayed healthcare-seeking. Conclusion: The COVID-19 pandemic substantially disrupted cervical cancer screening services, resulting in reduced smear uptake, an increased proportion of high-grade cervical lesions, and heightened psychological distress among women from both rural and urban populations. Strengthening routine cervical screening and implementing widespread human papillomavirus vaccination are essential to mitigate the long-term impacts of such disruptions in resource-limited settings like India.
Cystic hygromas are the most frequent kind of lymphangioma, appearing at birth or in early infancy. They are congenital lymphatic drainage system anomalies that frequently occur in the neck, clavicle, and axilla. They are most typically observed in young newborns or on prenatal ultrasounds, and depending on the anatomical placement, they may obstruct the airway. The optimal treatment is complete surgical excision; nonetheless, there is a steady shift to sclerosant therapy. The most common causes of surgical intervention are respiratory distress, infection, and cosmetic concerns. We are describing a rare case of axillary cystic hygroma in a 2-month-old male newborn that was treated surgically.
Background: Functional ability is a major factor in determining the health and quality of life, especially in rural India, where the geriatric population is growing. Objectives: This study aimed to evaluate the functional ability and its association with sociodemographic characteristics. Materials and Methods: In four villages of Bhatar Block, Purba Bardhaman, 299 elderly people 60 years of age and older participated in a community-based cross-sectional study. Simple random sampling was used, and a pretested and validated schedule was used for in-person interviews. The Katz activities of daily living (ADL) scale was used to measure functional ability and was analyzed using appropriate software. Results: About 41.1% of people had activity limitation, with the highest dependences seen in bathing and dressing (13.7%). ADL limitation was significantly associated with age (odds ratio [OR] = 0.2627, P < 0.0001) female gender (OR = 0.1642, P < 0.0001), religion (OR = 0.3923, P = 0.0031), caste (OR = 2.1758, P = 0.0233) living alone (OR = 4.0777, P < 0.0006), hypertension (OR = 3.4602, P < 0.0001), and both diabetes and hypertension (OR = 0.1923, P < 0.0001). Conclusion: A significant percentage of the elderly in this rural area have difficulties with everyday tasks, particularly with bathing and dressing. Functional independence is affected by sociodemographic risks such as age, female gender, caste, religion, living alone, and hypertension, and both hypertension and diabetes.
Ring entrapment on the finger is a common presentation in emergency and surgical practice. Prolonged impaction may lead to digital ischemia, necrosis, or even loss of the finger if not promptly managed. Conventional removal techniques may fail in cases involving hard metallic rings or significant edema. The use of a dental bur with long miniplate protection and copious saline irrigation presents a novel, accessible, and effective option. Here, we report the case of a 24-year-old patient who presented from a remote location with an entrapped metallic ring on the right ring finger for 1 1-year duration. The patient had progressive swelling and pain for 18 h, with early signs of vascular compromise. Standard removal attempts using lubrication, compression, and scissors were unsuccessful due to the thickness (3 mm) and hardness of the ring. A dental micromotor with a cutting bur was employed under adequate cooling, with saline irrigation maintained to prevent thermal injury. Additionally, a 2.0 mm miniplate was placed under the ring to prevent thermal and mechanical injury and provide support. The procedure was carried out successfully, resulting in the preservation of the finger and resolution of symptoms. The patient was prescribed antibiotics and pain relievers. The dental bur is a safe and effective alternative for removing impacted finger rings, particularly in resource-limited or emergency settings. Awareness and adoption of this technique may prevent complications and improve patient outcomes.
Inadvertent removal of an endotracheal tube (ETT) with an inflated cuff is a rare but potentially harmful event, leading to laryngeal trauma and other airway injuries. Here, we report a case where the ETT cuff remained inflated despite apparent pilot balloon deflation, resulting in resistance during extubation and mild post-extubation symptoms. This case report highlights the importance of proper tube fixation practices and the need for vigilance during extubation, especially when resistance is encountered.
Background: In recent years, considerable attention has been given to training medical students in establishing a trusting relationship with patients. Empathy is a key component in building a doctor–patient relationship. The current curriculum emphasizes such training of medical students. There is a paucity of research on effective interventions of empathy training in medical undergraduates. Aims: To compare role play and video demonstration as an effective teaching method of empathy in medical undergraduates. Materials and Methods: This cross-sectional study used the student version of the Jefferson Scale of Physician Empathy (JSPE-S) to assess 122 medical students. Students were exposed to both role play and video demonstration, with pretest and posttest conducted after each intervention. Results: There was a significant increase in empathy level after both video and role play were employed as teaching methods to improve empathy. It was noted that both video and role play were found to effectively improve empathy in females, whereas only video display proved efficacious in male students. In this study, empathy levels were significantly improved in technology-oriented specialities in both the video and role play interventions. While in people-oriented specialties showed higher empathy levels in the video demonstration only. Conclusion: Interventions focused on improving empathy levels in medical students are effective. Early clinical training and emphasis on gaining empathy as a competency according to the medical curriculum should not be underestimated.
Phosphaturic mesenchymal tumor is a rare neoplasm of soft tissue and bone that produces tumor-induced osteomalacia. These tumors are almost always benign and are typically associated with over expression of ‘fibroblast growth factor 23 (FGF23)’ that inhibits renal tubular phosphate re-absorption causing low serum phosphate, causing osteoporosis. This tumor usually occurs in middle-aged adults with slight female preponderance. Symptoms may range from chronic bone pain and pathological fractures to progressive muscle weakness. In this case report we aim to highlight the diagnostic modalities and utility of Immunohistochemistry in a case of Phosphaturic mesenchymal tumor (PMT). A 32 years old female presented with progressive nasal obstruction, discolored rhinorrhea, occasional nasal bleed from right nostril. Nasal endoscopy revealed a large, smooth, mucosa-covered mass filling the naso-pharynx. Serum calcium was within normal range whereas serum phosphorus and serum 1,25 dihydroxy vitamin D levels were reduced and raised Serum FGF-23 level. Histopathology revealed a tumor composed of sheets of oval to spindle cells with fine chromatin and inconspicuous nucleoli, interspersed by thin walled gaping vascular channels. On Immunohistochemistry, the tumor cells show positivity for vimentin and negative for SMA, CD34 and STAT6. Ki67 labeling index is 5%. Our final diagnosis was Phosphaturic mesenchymal tumor. PMTs are rare diseases with confusing clinical manifestations that can make them difficult to diagnose. Immunohistochemistry is an important adjunct to other diagnostic methods i.e. clinical manifestations, biochemical examinations, and imaging characteristics to help accurately diagnose PMTs. The histologic differential diagnosis of this tumor includes solitary fibrous tumor, mesenchymal chondrosarcoma, and paraganglioma. However, the immunophenotype of PMT (positive for FGF23 mRNA and negative for STAT6) is helpful in confirmation of diagnosis.
Repetitive night shift work among intensive care unit (ICU) healthcare workers creates significant health risks while potentially compromising patient safety. This critical commentary synthesizes recent evidence from randomized controlled trials, meta-analyses, and systematic reviews (2020–2025) examining the multi-faceted impacts of night shift work on ICU doctors and nurses. The evidence demonstrates substantial physical health consequences, including a 26% increased risk of cardiovascular disease and 57% increased risk of metabolic syndrome. Mental health impacts are equally concerning, with cognitive performance declining significantly (working memory capacity decreasing from 11.3 ± 0.3 to 9.4 ± 0.3, P < 0.001) and burnout affecting 50% of ICU personnel. Patient safety implications remain controversial, with some studies showing 44% higher error rates among sleep-deprived nurses, while major trials like ROSTERS paradoxically found increased errors when extended shifts were eliminated. Evidence-based interventions show promise, including strategic napping (20–30 min), light therapy (improving sleep time by 32.54 min), and melatonin supplementation (3 mg doses). However, intervention evidence remains limited by methodological quality concerns. Healthcare organizations must urgently address these challenges through comprehensive fatigue risk management systems while recognizing the essential nature of continuous ICU care. Future research should prioritize ICU-specific interventions and standardized outcome measures to optimize both healthcare worker wellbeing and patient safety.
Background: Though accepted globally as an effective learning strategy, the right approach for self-directed learning (SDL) is still controversial. There is no subject-specific guidance by the National Medical Commission for SDL in India, leading to inconsistent outcomes across the country. In the present study, we attempted to design and implement a structured module for SDL in physiology and evaluated its acceptability and effectiveness among the students and the faculties. Methods: It was a quasi-experimental educational study done on 138 phase 1 MBBS students and 11 faculties of physiology. In the first contact session, students were given a trigger on the selected topic and asked to generate their own learning objectives from it. Teachers guided them in this process and about books and literatures to be consulted. After 7 days, students came back and joined a group discussion facilitated by teachers. A multiple choice question-based test was taken at the end. Feedback about the session was obtained from both students and the faculty. Results: In the class test, 74.6% students scored ≥ 60%. The majority of students and faculties liked this learning approach and found it to be effective (Satisfaction indexes for faculty and students were 93% and 78%, respectively). Students opined for including more topics and more hours for SDL. Selecting topics, facilitating discussion, suggesting literatures, and solving queries emerged as fundamental roles of teachers in an SDL session from the feedback. Discussion and Conclusion: SDL initiated by an optimum trigger and facilitated by a teacher may be an effective approach for learning by the students
Penile fracture with urethral injury is an extremely rare condition that requires prompt surgical intervention. It is a dilemma for urologist when patient presents after long period with complications. Here, we report a case of penile fracture with urethral injury in a 31-year-old male, which was managed surgically after 7 months. Three months after surgery he had good flow of urine and preserved erection with satisfactory sexual intercourse.
Seborrheic keratosis is an epidermal tumor that rarely occurs in the genital region. We report a rare case of extensive seborrheic keratosis along with multiple urethrocutaneus fistulas in which total penectomy, scrotectomy, perineal urethrostomy, and relocation of bilateral testis were done.
Background: Neonatal hyperbilirubinemia (NH) affects up to 60%–80% of term and near-term infants and, when severe or delayed in treatment, can progress to acute bilirubin encephalopathy or permanent kernicterus. In Eastern India, late recognition and limited resources exacerbate the risk of lasting neurodevelopmental injury. Objectives: To determine the neurologic outcomes in NH neonates from Eastern India, identify key risk factors, and evaluate the impact of therapeutic interventions. Materials and Methods: We performed a 24-month prospective observational study at a tertiary-care center, enrolling preterm, term, and near-term neonates with total serum bilirubin ≥15 mg/dL. Neurologic assessments comprised bilirubin-induced neurologic dysfunction (BIND) scoring, brain imaging (ultrasound/magnetic resonance imaging), brainstem evoked response audiometry, and developmental screening at 6 months. Results: Hemolytic factors—glucose-6-phosphate dehydrogenase deficiency (18%), ABO blood group (14%), and positive direct Coombs test (16%)—were linked to significantly higher peak bilirubin (P < 0.01) and greater exchange transfusion (ET) rates (P < 0.001). In multivariable models, ET (odds ratio [OR]: 0.24; 95% confidence intervals [CI]: 0.10–0.60), higher peak bilirubin (OR: 0.88 per mg/dL; 95% CI: 0.82–0.95), baseline tone abnormalities (OR: 0.35; 95% CI: 0.16–0.77), and sepsis (OR: 0.42; 95% CI: 0.18–0.99) independently predicted poor BIND score improvement. Low 5 min Apgar (<7) and acidosis were the sole predictors of congenital anomalies. Peak bilirubin (OR: 1.10; 95% CI: 1.04–1.16), ET (OR: 3.88; 95% CI: 1.36–11.06), delayed feeding (OR: 2.73; 95% CI: 1.08–6.92), and congenital anomaly (OR: 4.52; 95% CI: 1.29–15.80) independently increased odds of abnormal neurodiagnostic findings. Conclusion: Early identification of risk factors and treatment was needed to mitigate irreversible neurologic damage.
The term “embolic stroke of undetermined source” (ESUS) encompasses a sizable and heterogeneous population of patients with ischemic stroke. The introduction of the ESUS concept way back in 2014 opened up a new avenue to accommodate all ischemic stroke patients with an undetermined cause after the recommended diagnostic assessment. Several mechanisms can be the source of embolism in an ESUS patient, ranging from complex carotid plaque, aortic arch atheroma, patent foramen ovale, and left ventricular (LV) dysfunction to atrial cardiomyopathy, dysrhythmias, and cancer, found subsequently on rigorous evaluation. The clinical construct of ESUS aimed to define a subset of patients who might benefit from oral anticoagulation (OAC) rather than the standard antiplatelet therapy. However, all randomized controlled trials and meta-analyses have failed to demonstrate the superiority of OAC in ESUS, apart from a few post hoc analyses demonstrating the efficacy of OAC in specific subgroups like enlarged left atrium, LV dysfunction, and covert atrial fibrillation. Therefore, after assessing overall thromboembolic risk, it is wise to assemble a phenotypically similar patient population and randomize them to targeted preventive strategies rather than assuming that all will benefit from anticoagulation.
