Background: Early detection of diabetic neuropathy is crucial for both health and economic stability. Clinically, timely diagnosis and intervention can prevent the progression to severe complications, significantly preserving a patient’s quality of life and mobility. Economically, this proactive approach reduces the long-term burden on healthcare systems. Objective: To assess and compare the early predictive value of different heart rate variability (HRV) parameters for the early detection of type 2 diabetes mellitus (T2DM)-induced neuropathy. And to evaluate their correlation with the novel serum parameters, Brain-Derived Neurotrophic Factor (BDNF), and Nesfatin-1. Results: HRV parameters showed early changes in type 2 diabetics, even before the development of overt neuropathy. We investigated early changes in heart rate variability parameters in a cohort of type 2 diabetic patients compared to age-matched healthy controls. We found that heart rate variability changes occur even before the development of neuropathic symptoms, suggesting that it can be used as an early detection measure in diabetic neuropathy. Also, we measured serum brain-derived neurotrophic factor and Nesfatine-1 in all study subjects and found brain-derived neurotrophic factor to show a stronger correlation with the HRV parameters than Nesfatine-1. This correlation was more significant in the diabetic patients than the healthy controls. Conclusion: We concluded that the HRV metrics can serve as sensitive early biomarkers for detecting type 2 diabetes mellitus-induced neuropathy, especially cardiac autonomic neuropathy, even in T2DM patients without clinical signs of neuropathy. Additionally, BDNF is superior to Nesfatin-1 for early detection of visceral autonomic neuropathy.
Background: Infant swaddling that restricts physiological hip flexion and abduction has been identified as a modifiable postnatal risk factor for developmental dysplasia of the hip (DDH). Despite increasing biomechanical evidence linking improper swaddling techniques to adverse hip development, caregiver-related determinants of hip-safe swaddling practices remain insufficiently characterized in Middle Eastern populations. Objective: To assess maternal knowledge of DDH and safe swaddling practices and to examine socio-demographic and informational factors associated with knowledge adequacy among mothers residing in Riyadh, Saudi Arabia. Methods: A cross-sectional web-based survey was conducted among mothers with at least one child aged ≤ 5 years living in Riyadh. Data were collected using a previously validated questionnaire assessing DDH awareness and swaddling practices. Knowledge scores were calculated and categorized using predefined thresholds. Associations between socio-demographic characteristics and knowledge levels were examined using Pearson’s Chi-squared test. Results: Among 436 respondents, the mean DDH knowledge score was 67%, while knowledge of correct swaddling practices averaged 46.9%. Higher maternal educational attainment and receiving infant care information from healthcare professionals were independently associated with adequate DDH knowledge. Early DDH screening before 6 months of age was also independently associated with adequate swaddling-related knowledge. Reliance on informal information sources, including family members and social networks, was more frequently observed among participants with lower knowledge scores. Conclusion: Maternal awareness of DDH does not consistently translate into knowledge of appropriate hip-safe swaddling techniques. Integration of anticipatory guidance on safe infant positioning into routine pediatric preventive care may represent a modifiable pathway for reducing caregiver-related DDH risk exposures during early infancy.
Brunner’s gland hyperplasia (BGH) is an uncommon benign proliferative condition of the Brunner’s glands. It is often asymptomatic and typically discovered incidentally during endoscopic procedures. We report a case of a patient with BGH diagnosed with endoscopic ultrasound biopsy after an initial negative endoscopic mucosal biopsy. A 52-year-old male presented with palpitations and exertional dyspnea as well as melenic stools of a 3-week duration. Laboratory testing was remarkable for a hemoglobin level of 5.9 g/dl and a mean corpuscular volume of 62 fl. Esophagogastroduodenoscopy and mucosal biopsy were inconclusive, necessitating endoscopic ultrasound with fine-needle biopsies. Due to bleeding, the mass was resected, and histological examination revealed the diagnosis of BGH. This case underscores the importance of considering BGH in the differential diagnosis of gastrointestinal bleeding.
Background: Adolescence is a vital phase of physical and psychological development, often accompanied by nutritional and mental health challenges. Adolescent girls are especially vulnerable due to the physiological demands of puberty and evolving lifestyle behaviours. Objectives: To assess the epidemiological correlates of nutritional status and screen exposure among adolescent girls. To study the determinants of mental health difficulties through behavioural screening using the Strengths and Difficulties Questionnaire (SDQ). Methods: This community-based cross-sectional study was conducted from June 2023 to June 2024 among 230 adolescent girls aged 13–17 years in the field practice area of RHTC, Pohir, selected through systematic random sampling. Data on sociodemographic profile, diet, physical activity and screen exposure were collected using a pretested questionnaire. Behavioural screening was done using SDQ. Relevant statistical tests were applied. Results: Among the 230 participants, 24.9% were thin and 10.5% overweight/obese. Central obesity was found in 7.4% which was significantly associated with overweight/obesity ( P < 0.001). Calorie intake showed a significant association with BMI ( P < 0.001). Screen exposure >2 hours/day was reported by 57.8% and was significantly associated with insufficient sleep ( P = 0.007), spectacle use ( P = 0.01) and mother’s occupation ( P < 0.001). Based on SDQ scores, 76.1% had normal, 14.8% borderline and 9.1% abnormal total difficulties scores. Conclusion: Adolescent girls exhibited malnutrition and mental health concerns, with screen exposure and dietary patterns playing a significant role. Early and targeted interventions are essential to address these risk factors and promote holistic adolescent health.
Introduction: Paraquat (dipyridylium) is1-methyl-4-(1-methylpyridin-1-ium-4-yl) pyridin-1-ium a quaternary ammonium herbicide. It is a highly toxic herbicide primarily used to control grass and weeds. World health organization Recommended Classification of Pesticides by Hazard identifies paraquat as class II moderately hazardous herbicide. Due to the lack of effective treatments to be used in humans for paraquat poisoning the mortality is high ranges from 60% to 80%. Present study has been designed to analyses all cases of paraquat poisoning admitted in department of emergency medicine Konaseema institute of medical science Amalapuram Andhra Pradesh, to know the clinicoepidemiological pattern and outcome of treatment. Material and Method: This is a retrospective case record-based study conducted in the department of emergency medicine and general medicine Konaseema institute of medical science and research foundation Amalapuram India. Result: The amount of poison consumed was significantly higher among non-survivor (22.2 ± 12.2 ml vs 154.4 ± 99.0 ml). Fatality was more common, who has consumed paraquat with alcohol then those who has consumed without alcohol that was 72% patients. Discussion and Conclusion: From present study we can conclude that amount of paraquat consumed and time required to visit to the hospital (hrs) was significantly associate with higher incidence of death. Elevated liver enzyme and lung damage as visible in chest x ray is important predictor for mortality.
Traditional dietary patterns of isolated indigenous populations have repeatedly demonstrated protective effects against non-communicable diseases (NCDs), yet most defined, named and operationalized protective dietary patterns originate from European or Western contexts. Here characterization of the traditional dietary pattern of the Pangwal and Bot (Bhot) communities of Pangi Valley, Himachal Pradesh, India hereinafter termed the, “Pangi Valley Diet (PVD)” as a distinct, named, and scientifically grounded protective dietary pattern analogous to geographically bounded, ecologically constrained dietary pattern whose structural features parallel other cardio metabolic-protective traditional diets like the Mediterranean diet is being proposed. Drawing exclusively on existing ethnographic, nutritional, and ecological literature, this paper describes the compositional features of the PVD, maps its active bioactive constituents to known NCD-protective mechanisms, and proposes a preliminary scoring framework for its operationalisation in research and clinical contexts. The PVD is characterized by low-glycemic index whole grains, fermented foods, high-altitude yak and chauri dairy with favorable fatty acid profiles, wild edible plants with high antioxidant and phytochemical loads, near-zero refined carbohydrate and processed food content, and a naturally favorable sodium-to-potassium ratio. These features, emerging from ecological constraint and centuries of agro-pastoral adaptation rather than dietary prescription, collectively constitute a biologically plausible protective dietary pattern.
Same-day tuberculosis (TB) diagnosis and treatment initiation are increasingly promoted to reduce delays in care and loss to follow-up. Rapid molecular diagnostics have made this feasible, but their implementation among marginalized rural populations presents important challenges. An exclusive focus on speed may compromise diagnostic quality and patient-centred care in settings marked by chronic malnutrition and limited access to healthcare. Chronic malnutrition may impair sputum production, reducing specimen quality and diagnostic sensitivity, while socioeconomic constraints shape care-seeking and continuity of care. Drawing on experience from rural primary healthcare, we argue that diagnostic strategies should balance speed, specimen quality and patient-centred care. Flexible, context-specific approaches, rather than a universal emphasis on same-day diagnosis, are needed to improve TB care among vulnerable populations.
Background: Pancreatic cancer (PC) is the seventh-leading cause of cancer-related death worldwide. Studies have established a 2-fold risk of PC among individuals with diabetes mellitus (DM). In this study, we aimed to determine the prevalence and biochemical correlates of DM and in PC patients. Methods: The current retrospective cross-sectional study was conducted between 2016 and 2022. The study sample included all patients aged >18 who were admitted after a primary diagnosis of PC at our center. A comprehensive review of the charts was conducted to gather demographic data, including diabetes and ABO Rh blood group (BG). Results: A total of 186 PC patients were included, 76 (40.9%) of whom were females and 110 (59.1%) were males. DM was found in 120 (64.5%) patients, of whom 125 (67.2%) were diagnosed pre-PC and constituted 72 (60%) males and 48 (40%) females. The most prevalent type of PC was adenocarcinoma (68.6%), with stage IV being 97.8% of the cases. The most common BG among PC patients was type O in 68 (36.6%) patients, followed by type A in 45 (24.2%). Also, 124 (66.7%) were Rh-positive, while 14 (7.5%) were Rh-negative. Serum CA19-9 was the most commonly detected biomarker, present in 27.4% of patients. Conclusion: The percentage of DM among PC patients was found to be 64.5%, of whom 3.8% were diagnosed after the diagnosis of PC. Blood group O was the most common; however BG type B was associated with a higher risk of DM in ( P = 0.028) in PC patients.
Granulomatosis with polyangiitis (GPA) is a rare Antineutrophil Cytoplasmic Antibodies (ANCA)-associated vasculitis that typically affects the upper and lower respiratory tract and kidneys. In adolescents, atypical presentations with predominant neuro-otological features may delay diagnosis. We report a 15-year-old boy who presented with progressive bilateral sensorineural hearing loss, facial nerve palsy, multiple lower cranial nerve deficits, dysphagia, and hoarseness, initially suggestive of chronic meningitis. Magnetic resonance imaging showed pachymeningeal enhancement with skull-base involvement. There was no renal or classical sinonasal involvement. Pulmonary infiltrates were initially attributed to aspiration pneumonia, and an infectious etiology was suspected. Prolonged antimicrobial therapy, however, did not result in sustained improvement. Lung biopsy demonstrated necrotizing granulomatous inflammation, and PR3-ANCA positivity confirmed GPA. Immunosuppressive therapy led to marked clinical improvement. Predominant neuro-otological involvement with misleading pulmonary findings can pose a significant diagnostic challenge in adolescent GPA.
A patient aged around 52 years visited Faculty dental centre, Al Baha University with pain and discomfort in chewing. He was dentist by profession with multiple restoration with a perception of deep caries and further to root canal treatment. He had a complaint of pain or discomfort while chewing, as he was dentist in profession, he had teeth restored due to caries from many years back. On assessment of caries risk, it was observed there was no new incidence of caries which was supportive with his lifestyle changes with disciplined eating and balanced diet with micro and macro nutrients. The patient’s perception was changed later with self-evaluation of caries status. There was cessation of caries or further progress in many teeth which is a good indication for oral and general health.
Rural primary health care (PHC) teams often encounter complex cases where outcomes are impacted by limited access to diagnostics and delayed referrals. Achieving positive health outcomes in such contexts depends on a dynamic interplay of biopsychosocio-ecological factors influencing individuals, organizations, and society. These factors contribute to delays in seeking, reaching, and receiving care. Moreover, a mismatch often exists between problem-solving, learning needs, culture of primary care teams, and the frameworks used by educators and policymakers in health system design. In this context, an interprofessional group of primary care and health system practitioners, educators, and researchers presents an illustrative case of a tribal adolescent girl in rural Rajasthan, India. Her diagnosis, referral, and recovery were successfully managed by a rural primary care team comprising a physician, physiotherapist, community nurse, counselor, and outreach workers. Using the “Three Delays Framework”, we analyzed the team’s functioning that enabled early recognition and effective management of a complex condition. We identified cultural and structural elements that fostered quality in learning and problem-solving—specifically, interprofessional collaboration, plurality, “porous” and flattened team hierarchies, and reflexive, adaptive learning. This paper is aimed at primary care practitioners, educators, health systems designers, and policy makers whose thinking and decisions shape comprehensive PHC. We particularly highlight the need to consciously foster a culture of learning and problem-solving in primary care teams.
