European Journal of Cardiovascular Medicine

Drug-eluting balloons (DEBs) have emerged as a promising alternative to drug-eluting stents (DES) for the treatment of coronary artery disease (CAD), particularly in small vessels and in-stent restenosis (ISR). In India, the DEB market has grown rapidly due to the increasing burden of cardiovascular disease, improved healthcare access, and innovation from indigenous manufacturers such as Meril (MOZEC SEB) and Concept Medical (MagicTouch). DEBs deliver antiproliferative drugs—most commonly paclitaxel or sirolimus—via short-duration balloon inflation, achieving effective drug transfer without leaving a permanent implant. Comparative studies and post-marketing surveillance (PMS) in India demonstrate favorable safety and efficacy of sirolimus-coated balloons (SCBs), with low rates of target lesion revascularization (TLR) and major adverse cardiac events (MACE). While paclitaxel-coated balloons (PCBs) have historical precedence, sirolimus-based platforms are gaining traction due to improved vascular healing and biocompatibility. Although most Indian data are observational or registry-based, outcomes are consistent with international results, indicating that DEBs—especially SCBs—represent a safe and effective “leave-nothing-behind” strategy for coronary revascularization.

Aim & Objective: To evaluate the association between Meibomian Gland Dysfunction (MGD) and dyslipidemia in adult patients attending a tertiary care hospital, and to determine the diagnostic utility of lipid parameters in predicting MGD. Background/Introduction: MGD is a leading cause of evaporative dry eye, commonly associated with alterations in the lipid layer of the tear film. Emerging evidence suggests that systemic lipid abnormalities, particularly elevated cholesterol and triglyceride levels, may contribute to the pathogenesis of MGD. This study investigates the relationship between dyslipidemia and MGD to support early systemic screening and holistic management strategies. Material & Methods: A hospital-based age- and sex-matched case–control study was conducted involving 70 MGD patients and 70 controls. Diagnosis of MGD was based on clinical criteria including gland expressibility and meibum quality. Fasting lipid profiles were assessed in all subjects. Statistical analyses included t-tests, Pearson correlation, and ROC curve analysis to evaluate the association and predictive value of lipid indices. Results: MGD patients had significantly higher mean levels of total cholesterol, LDL, and triglycerides, and significantly lower HDL levels compared to controls (p < 0.001). Positive correlations were observed between MGD and total cholesterol (r = 0.637), LDL (r = 0.627), and triglycerides (r = 0.601); HDL showed a negative correlation (r = –0.626). Total cholesterol had the highest predictive accuracy for MGD (AUC = 0.882). Conclusion: Dyslipidemia, especially elevated total cholesterol and LDL, is significantly associated with MGD. Serum lipid profiling can aid in early identification and integrated management of patients with MGD.

Background: Anaemia is characterised by a reduced haemoglobin concentration relative to that of age-matched controls. The World Health Organisation defines anaemia as a haemoglobin level below 13 g/dl in adult males, below 12 g/dl in adult females, and below 11 g/dl in pregnant females. AIM: To assess and describe the clinical presentation and underlying etiological factors of anaemia among adult patients Methodology: This hospital-based observational study was conducted in the Department of Family Medicine and General Medicine at Mahatma Gandhi Medical College and Hospital from March 2023 to August 2024. Result: The study found that iron deficiency–related nutritional anemia was the predominant type, with most patients presenting moderate anemia and microcytic blood picture. Generalized weakness and fatigue were the most common symptoms, and females and vegetarians were the most affected groups. Conclusion: The study highlights nutritional deficiency—especially iron deficiency—as the leading cause of anemia among adults, predominantly affecting young females and vegetarians. Early detection and targeted nutritional interventions are essential to reduce the overall disease burden.

Background: Advances in cardiopulmonary bypass and operative techniques have significantly improved outcomes in cardiac surgery. However, in view of increasing complexity of diseases which require intervention, reliable risk-stratification models to predict operative mortality is essential for such patients. The EuroSCORE (European System for Cardiac Operative Risk Evaluation) is a widely validated tool designed to estimate surgical risk based on 17 clinical and operative variables.  Aim: To evaluate the relationship between additive and logistic EuroSCORE and postoperative mortality in adult cardiac surgery patients, and to assess the predictive accuracy of EuroSCORE across low-, medium-, and high-risk groups. Methods: This prospective study included 100 adult patients undergoing open-heart surgery with cardiopulmonary bypass at Tertiary care teaching hospital in North India. The study was conducted April 2014–March 2016. EuroSCORE was calculated preoperatively using 17 predefined risk factors. Patients were classified into low-risk (1–2), medium-risk (3–5), and high-risk (≥6) groups. Primary outcomes included 30-day in-hospital mortality. Data were analysed using SPSS 16.0 with Chi-square tests; p-value < 0.05 was considered significant. Results: The mean age of the cohort was 52.17 years, with the majority of the patients being in the medium-risk group. Overall mortality of patients undergoing cardiac surgery irrespective of the indication of surgery was 13%, compared to the EuroSCORE-predicted mean logistic mortality of 7.04%. Observed mortality was 0% in the low-risk group, 2.27% in medium-risk, and 50% in high-risk patients. The strongest predictors of mortality included serum creatinine >200 mmol/L, critical preoperative state, LVEF <30%, recent myocardial infarction, emergency surgery, complex procedures, COPD, active endocarditis, unstable angina, and postoperative infarction (all p-values being < 0.05).  Conclusion: EuroSCORE is a simple, objective, and valuable tool for risk prediction in adult cardiac surgery and performs well in low- and medium-risk Indian patients. The strongest determinants of mortality were renal dysfunction, critical preoperative status, low LVEF, high ischemic burden on heart, complexity of surgeries and in emergency over elective cases. However, it underestimates mortality in high risk groups. While we have assessed the performance of the original EuroSCORE, another EuroSCORE II has been launched which  has not yet undergone extensive external validation

Background: Introduction- Statin intolerance can jeopardize treatment adherence and cardiovascular risk reduction, although statins are still the mainstay of lipid-lowering therapy. Distinguishing actual statin intolerance from pseudo-intolerance is crucial to improving therapy and reducing harmful consequences. In the present study, we aimed to investigate the frequency of documented SI, true or false, in patients attending outpatient department of our centre.Material and methods- 456 patients with age above 40 years participated in a prospective study at Government Medical College, Doda. The European Atherosclerosis Society criteria and the statin myalgia clinical index score were used to assess statin intolerance. Patients were divided into three categories: probable (true) intolerance, possible intolerance, and no intolerance. Over a period of six months, cardiovascular outcomes were documented. Results- The mean age of the study population was 58.7 years. A higher proportion of males (61.4%) participated in the study. The baseline lipid parameters showed elevated LDL-C (146.2 ± 32.8) and triglyceride 162.4 ± 41.5) levels across the cohort. More than half of the study population (55.7%) received moderate-intensity statins. High-intensity statin therapy was initiated in 25.9% of patients. A smaller percentage (18.4%) of participants received low-intensity regimens.17.1% demonstrated some level of intolerance—10.5% were categorized as having false intolerance, while 6.6% fulfilled the criteria for true or probable intolerance. Patients with true intolerance showed significantly higher rates of creatine kinase (CK) elevation and earlier onset of myalgia symptoms (mean onset 4.2 weeks) compared with pseudo-intolerant individuals, who reported symptoms later (mean onset 7.8 weeks). A significantly higher proportion of females experienced true intolerance. High-intensity statin use was also more prevalent in the true intolerance group (66.7%). Patients with any degree of intolerance demonstrated higher rates of adverse outcomes, including all-cause mortality (7.7% vs. 3.2%) and myocardial infarction (10.3% vs. 3.7%), both of which reached statistical significance.  Conclusion- True statin intolerance was relatively rare; however, both true and pseudo-intolerance were linked to negative cardiovascular outcomes. To keep lipid-lowering therapy going and avoid unnecessary discontinuation, it is important to accurately identify, manage, and counsel patients.

Background: Lumbar disc herniation (LDH) associated with stable grade I degenerative lumbar spondylolisthesis (DLS) presents a surgical challenge, as decompression may risk postoperative instability. Unilateral biportal endoscopic discectomy (UBED) has emerged as a minimally invasive alternative offering effective decompression with minimal tissue disruption. This study aimed to evaluate the clinical and radiological outcomes of UBED in patients with LDH and concomitant stable grade I DLS. Methods: A retrospective analysis was conducted on 55 patients diagnosed with LDH and stable grade I DLS who underwent single-level UBED between January 2020 and June 2023 at MKCG Medical College and Hospital, Berhampur, Odisha. Demographic, perioperative, and follow-up data were retrieved from medical records. Pain and disability were assessed using the Visual Analogue Scale (VAS) and Oswestry Disability Index (ODI), respectively. Preoperative and postoperative comparisons were analyzed using paired t-tests, with p < 0.05 considered statistically significant. Data were analyzed using R software (version 4.3.0). Results: The study cohort included 16 males and 39 females with a mean age of 71.4 ± 8.6 years and an average follow-up of 22.6 ± 9.2 months. Pain and functional outcomes improved significantly following surgery: mean VAS for back pain decreased from 6.8 ± 1.0 to 2.1 ± 0.9 (p < 0.001), and VAS for leg pain from 7.4 ± 0.9 to 1.8 ± 0.8 (p < 0.001). The ODI score improved from 63.5 ± 7.8% to 20.7 ± 6.9% (p < 0.001). Although the mean slippage percentage increased slightly from 10.8 ± 2.9% to 11.4 ± 3.1%, and disc height reduced marginally from 9.2 ± 1.3 mm to 9.0 ± 1.4 mm, these changes were not statistically significant.  UBED provided substantial pain relief and functional recovery with minimal perioperative morbidity and without causing postoperative instability. The procedure’s minimally invasive nature, shorter learning curve, and early mobilization benefits make it particularly suitable for elderly patients with stable DLS in resource-limited centres. Conclusion: UBED is a safe, effective, and minimally invasive technique for treating LDH with stable grade I DLS, offering significant symptomatic improvement, minimal blood loss, early ambulation, and radiological stability during follow-up. It represents a viable surgical alternative to conventional discectomy or fusion, particularly in elderly patients.

Background: Healthcare-Associated Infections (HAIs) pose a considerable threat to patient safety, particularly in pediatric hospital settings in low- and middle-income countries. Hand Hygiene (HH) is the cornerstone of infection prevention, but the focus often neglects the patient's role. This study aimed to comprehensively assess the Knowledge, Attitude, and Practice (both self-reported and directly observed) of HH among hospitalized school-age children (10-12 years) admitted to a major tertiary care hospital in Cuttack, India. Methods: A multi-center, descriptive cross-sectional study was conducted, enrolling a total of 250 children aged 10-12 years from the general pediatric wards of SVPPGIP and Sishu Bhaban, Cuttack. Data collection involved a structured, pre-tested questionnaire for KAP assessment and a standardized checklist for covert observation of HH practice before a meal. Good Knowledge was defined as a score ≥70%, and Adequate Observed Practice (OP) as adhering to ≥5 of the 7 WHO steps for ≥20 seconds. Statistical analysis included descriptive statistics and the Chi-square test (χ2) to test for associations. Results: The mean Knowledge score was 7.2±1.8 out of 10, with 58% of children achieving Good Knowledge. Attitude was overwhelmingly Positive (96% agreement that HH prevents illness). However, only 28% of children demonstrated Adequate Observed Practice (OP). A highly significant statistical association was observed between Good Knowledge and Adequate Observed Practice (χ2=10.51,p=0.001). Furthermore, children whose parents had achieved a Graduate/Post-Graduate education level exhibited significantly better OP compared to those with lower parental education levels (χ2=11.08,p=0.012). Conclusion: A substantial and concerning gap exists between the pediatric patients' awareness and their actual hand hygiene performance. Hospital infection control strategies must shift from passive education to active, skill-based training and robust caregiver engagement to ensure the correct technique and duration are consistently applied, thereby reducing patient-initiated infection risk.

Background: Stroke is one of the leading causes of mortality and disability worldwide, with diabetes mellitus recognized as a major modifiable risk factor. Glycated hemoglobin (HbA1c) reflects long-term glycemic control and has been proposed as a potential marker for predicting stroke risk even in non-diabetic individuals. This study aimed to evaluate the relationship between HbA1c levels and ischemic stroke in diabetic and non-diabetic patients admitted to a tertiary care hospital in eastern India. Materials and Methods: A hospital-based, descriptive, case–control study was conducted in the Department of General Medicine, PGIMER & Capital Hospital, Bhubaneswar, Odisha, over six months (October 2024–March 2025). A total of 240 inpatients with acute ischemic stroke were included—120 diabetics and 120 non-diabetics—aged ≥18 years. Detailed history, clinical examination, and investigations including HbA1c, fasting and random blood glucose, lipid profile, and blood pressure were recorded. Data were analyzed using R software (version 4.3.2), with p < 0.05 considered statistically significant. Results: The majority of stroke cases (58%) occurred in patients aged 51–70 years. Based on glycemic status, 50% were known diabetics, 5.4% were newly diagnosed, 12.9% had stress hyperglycemia, and 31.7% were euglycemic. The mean HbA1c level was significantly higher among diabetic patients (7.85 ± 2.30%) compared to non-diabetics (6.25 ± 2.10%, p < 0.01). Although diabetics also had higher mean values of fasting blood sugar, lipid parameters, and blood pressure, these differences were not statistically significant. Discussion: The study demonstrates that elevated HbA1c levels are strongly associated with ischemic stroke, independent of other risk factors. These findings are consistent with previous studies that identified HbA1c as a reliable predictor of vascular risk and subclinical atherosclerosis. Routine HbA1c assessment in acute stroke cases can identify undiagnosed diabetes or prediabetes and guide early preventive interventions. Conclusion: Higher HbA1c levels are significantly correlated with the occurrence of ischemic stroke. Poor long-term glycemic control may contribute to increased cerebrovascular vulnerability in diabetics and may also signal higher risk among non-diabetics. Monitoring and management of hyperglycemia should therefore form an integral part of acute and long-term stroke care.

Background: Chronic kidney disease (CKD) has been recognized as a leading public health problem worldwide. Electrocardiogram (ECG) has emerged as an invaluable diagnostic tool for assessing cardiovascular risk in Chronic Kidney Disease (CKD) patients, offering vital insights into cardiac health and potential complications. Consequently, the article investigates how the electrocardiographic (ECG) patterns change in different stages of Chronic Kidney Disease (CKD) among patients presenting at the Outpatient Department (OPD) of a tertiary healthcare facility. This cross-sectional study conducted at the Department of Physiology, SCBMCH, Cuttack, Odisha, from December 2019 to October 2021, aimed to investigate electrocardiographic (ECG) pattern changes in different stages of Chronic Kidney Disease (CKD) among patients. The study employed simple random sampling techniques, and due to the constraints posed by the COVID-19 pandemic, the sample size was limited to 139 individuals with CKD and End-Stage Renal Disease (ESRD). Cochran's formula is primarily used for calculating the sample size needed when conducting surveys or collecting data from a large population, especially for qualitative data. Microsoft Office Student Edition 2019, often recognized for its robust suite of productivity applications, provides researchers with a versatile and efficient platform for data analysis, documentation, and presentation. The comparison of ECG pattern changes in different stages of CKD highlights the increasing severity of cardiovascular implications as CKD advances. Therefore, a 5% margin of error was used to calculate the sample size (CI = 95%). The study on ECG pattern changes in different stages of Chronic Kidney Disease (CKD) presented at the Outpatient Department (OPD) of a tertiary healthcare facility has shed crucial light on the intricate relationship between CKD and cardiovascular health. In this descriptive cross-sectional study, Electrocardiographic (ECG) changes in Chronic Kidney Disease (CKD) patients were investigated. The results revealed R- S intervals in Lead 1 and Lead aVF showed no significant association with CKD stages, while T-wave height and ST-T intervals exhibited no substantial changes across CKD stages. However, PR intervals displayed some variation among CKD stages. Interestingly, QRS duration demonstrated no significant differences in CKD stages, while QTc duration exhibited significant variations across CKD stages. These findings provide valuable insights into the ECG changes associated with CKD, though further research for broader validation is acceptable.

Background: Consultation-liaison psychiatry (CLP) provides a fit vantage point for watching the changes that permit prediction of future directions in psychiatry as a medical discipline. Along with these facilities it also caters to different departments   who seeks psychiatric referrals. Aims: The study aimed to identify the reasons for psychiatric referrals and the hospital departments requesting them. It also examined the primary illnesses leading to admission and described the demographic profile of patients referred for psychiatric consultation. Materials & Methods: This study is a cross-sectional study conducted at the Department of Psychiatry, Nil Ratan Sircar Medical College and Hospital, over a duration of three months, with a total sample size of 210 patients. Result: Among the study participants, the largest proportion were from the General Medicine department (47.5%), followed by Surgery (19.2%) and Obstetrics & Gynecology (14.6%). Smaller percentages were from Orthopedics (8%), Pediatrics (2.1%), and other departments (8.6%).The most common cause of psychiatric consultation in the study was deliberate self-harm (DSH), accounting for 37.9% of cases, followed by alcohol-related disorders (19.5%), delirium (12.8%), and insomnia (11.2%). Conclusion: We concluded that highlights a clear pattern in psychiatric referrals within a tertiary care hospital in Eastern India, with males and patients from lower socioeconomic strata constituting the majority, indicating potential gender and socioeconomic influences on healthcare access and psychiatric vulnerability. Most referrals originated from General Medicine, followed by Surgery and Obstetrics & Gynecology, reflecting the predominance of medical illnesses in psychiatric consultations.

Background: Emotional Intelligence is one of the very important predictors of psychological disorders dealing with mental health. Present study was conducted to analyze gender differences in mental health and EI of first year medical students and to find out the inter-relationship between them in both genders. Material And Methods: The present study was conducted in the Department of Physiology GMC Kathua.100 medical students participated in this cross-sectional study. Mental health was assessed by General Health Questionnaire-12 (GHQ-12) and EI by Trait Emotional Intelligence Questionnaire-short form (TEI Que-sf). Results: GHQ -12 score was significantly higher in females and higher prevalence of mental health disturbance as compared to males.  It was reported that higher emotional intelligence is consistently associated with lower psychological distress across both groups. Reliability analysis confirmed acceptability to good internal consistency for all scales used. Conclusion: The study demonstrated that female medical students experienced significantly higher psychological distress compared to males, as reflected in GHQ-12 scores. However, emotional intelligence- both global and across sub-domains did not differ significantly between genders, indicating broadly similar emotional profiles. Across both sexes, higher emotional intelligence was moderately and inversely correlated with psychological distress.

Background:  Sepsis remains a major cause of ICU mortality worldwide, with clinical outcomes varying markedly among patients. Emerging evidence suggests that biological variability, including ABO blood group phenotype, may influence sepsis prognosis. Aim: To evaluate the association between ABO blood group and mortality in patients with sepsis admitted to the Intensive Care Unit. Materials and Methods A hospital-based observational study was conducted among 240 sepsis patients admitted to the ICU. Clinical parameters including qSOFA score, Glasgow Coma Scale (GCS), total leukocyte count (TLC) and blood group were recorded. Outcomes were compared using Chi-square test and logistic regression, with p < 0.05 considered significant. Results: Mortality was highest in blood group O (45%), followed by AB (41.7%), B (36.7%) and A (30%). qSOFA ≥ 2, GCS ≤ 8 and markedly elevated TLC were significantly associated with mortality. Logistic regression confirmed blood group O as an independent predictor of mortality (OR 1.8; p = 0.031). Conclusion: ABO blood group shows a significant association with mortality in sepsis, with blood group O patients exhibiting the highest risk. Incorporating blood group with clinical risk assessment tools may enhance early prognostication and improve ICU outcomes.

Background: Lactate is an essential biomarker in evaluating critically ill patients. While Arterial Blood Gas (ABG) analysis is the standard method for assessing lactate, Venous Blood Gas (VBG) analysis is less invasive and more feasible in emergency settings (1). This study aimed to determine the correlation between venous and arterial lactate levels and evaluate the clinical utility of venous lactate as a surrogate marker. Methods: A prospective observational study was conducted on 102 critically ill patients (NEWS score >5) presenting to the emergency department or admitted to the ICU of AVMC&H. Simultaneous ABG and VBG samples were obtained at presentation and again after 2 hours of resuscitation. Lactate levels were measured and compared using paired t-tests, Bland-Altman analysis, and regression methods. Results: The mean age of patients was 53.1 years (SD ±14.1), with a male predominance (58.8%). The most common diagnosis was sepsis (35.3%). Mean initial lactate levels were 2.81 mmol/L (ABG) and 3.98 mmol/L (VBG). After resuscitation, levels dropped to 1.81 mmol/L (ABG) and 2.72 mmol/L (VBG). A strong correlation was observed between ABG and VBG lactate levels (r = 0.92), especially at lactate levels ≤2 mmol/L. The agreement declined at higher values. Conclusion: Venous lactate levels show a strong correlation with arterial levels and may be used reliably as a screening tool in critically ill patients, particularly when lactate levels are low. However, arterial sampling remains crucial at higher lactate levels for accurate assessment and prognostication.

Background: Anemia represents a major public health challenge in children, especially in low- and middle-income countries like India, where iron deficiency anemia (IDA) predominates among microcytic hypochromic anemias. This cross-sectional study at Maheshwara Medical College Hospital evaluated the Mentzer Index (MI = MCV/RBC count; >13 indicative of IDA) as a screening tool for IDA against serum ferritin (<15 ng/mL) as the gold standard in 100 anemic children aged 1-14 years, excluding those with recent transfusions, iron therapy, or blood loss. Most participants (66%) were 5-11 years old, 58% male, and from lower socioeconomic groups, with moderate anemia prevalent (78%). Hematological findings included mean hemoglobin of 9.28 g/dL, MCV of 64.40 fL, and serum ferritin of 55.30 ng/mL; 52% had low ferritin, and 85% showed MI >13. MI demonstrated high sensitivity (92.31%, 95% CI: 81.46-97.86) but low specificity (26.92%, 95% CI: 12.03-37.31), with positive predictive value (PPV) of 56.47% and accuracy of 59.00%; ROC analysis yielded an AUC of 0.635 (p=0.028). Significant associations emerged between MI and serum ferritin (p=0.033), age, and anemia severity. Compared to other studies, MI's sensitivity aligns with high-detection reports (e.g., 95.24% in Ahmed et al.), but specificity varied due to thalassemia trait overlap. These results affirm MI as a cost-effective initial screener for IDA in resource-limited pediatric settings, though confirmatory tests like ferritin are essential owing to suboptimal specificity. Routine integration could enhance early intervention amid India's 67% anemia prevalence (NFHS-5), curbing growth and cognitive impairments.

Background: Acute myocardial infarction (AMI), a major manifestation of coronary artery disease (CAD), remains a significant global health burden. Depression is increasingly recognized as an independent risk factor for adverse cardiac outcomes and a common complication following AMI, yet it is often underdiagnosed in low- and middle-income countries like India. This study aimed to determine the prevalence and determinants of depression among survivors of a first episode of AMI. Methods: A cross-sectional study was conducted in the Department of Cardiology at a multispecialty teaching hospital. A total of 551 adult survivors of a first episode of AMI were enrolled. Sociodemographic and clinical data were collected using structured questionnaires, and depression was assessed using the Patient Health Questionnaire-9 (PHQ-9). The prevalence of depression was calculated, and its association with sociodemographic and clinical variables was assessed. Results: Among 551 patients, the majority aged between 51–70 years (62.5%). The prevalence of depression (PHQ-9 >9) among AMI survivors at one month was 27.2%. While out of total sample, 23.0% had no depression (PHQ-9 = 0), 76.9% reported at least one depressive symptom (PHQ-9 ≥1). Severity distribution showed 39.6% had minimal depression, 10.2% mild depression, 20.1% moderate depression, 4.9% moderately severe depression, and 2.2% severe depression. Female gender was significantly associated with higher depression rates (χ² = 38.288, p = 0.001; odds ratio [OR] = 6.55, 95% confidence interval [CI]: 3.71–11.58).  Conclusion: This study demonstrates that more than one-fourth of AMI survivors experience clinical depression within one month of the event, and the majority report at least some depressive symptoms. Routine depression screening and incorporation of psychosocial interventions into cardiac rehabilitation are imperative to improve quality of life and long-term outcomes in AMI survivors.

Background: Introduction: Rotator cuff pathology is one of the most frequent causes of shoulder pain and disability, significantly affecting daily activities and work productivity in adults. Among the components of the rotator cuff, the supraspinatus tendon is most commonly involved due to its critical role in shoulder abduction and its susceptibility to mechanical impingement and degenerative changes. Aims: The aim of this study was to compare the effectiveness of platelet-rich plasma and corticosteroid injections in patients with partial-thickness supraspinatus tendon tears by evaluating improvement in pain, shoulder function, and radiological healing outcomes. Materials & Methods: This study is a prospective, randomized controlled trial (RCT) conducted at Department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medical Education & Research (IPGME& R) and SSKM Hospital over a period of one year, from 1st February 2018 to 31st January 2019. A total of 100 patients presenting with symptomatic partial-thickness supraspinatus tendon tears were enrolled for the study. Result: Healing rates were also higher in the PRP group, with 43 participants (86%) achieving complete or partial healing compared to 35 participants (70%) in the corticosteroid group (p = 0.05), and patient satisfaction was significantly greater (86% vs. 64%; p = 0.01). The incidence of adverse events was comparable between groups (22% vs. 28%; p = 0.52). Conclusion: We concluded that based on our study, platelet-rich plasma (PRP) injections demonstrated superior efficacy compared to corticosteroids in managing partial-thickness supraspinatus tendon tears. Both groups were comparable at baseline in terms of age, gender distribution, and affected side.

Background: Attention Deficit Hyperactive Disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood, characterized by age-inappropriate levels of inattention, hyperactivity, and impulsivity that interfere with academic performance, social interactions, and daily functioning. The global prevalence of ADHD among school-aged children is estimated to be approximately 5–7%, making it a significant public health and educational concern. Aims: To assess the level of knowledge and attitude of primary school teachers regarding Attention Deficit Hyperactive Disorder (ADHD) and to identify gaps that may affect classroom management and student learning outcomes. Materials & Methods: This study was conducted as a descriptive cross-sectional study at Institute of Postgraduate Medical Education & Research (IPGME& R) and SSKM Hospital, 244, Acharya J.C. Bose Road, Kolkata, West Bengal, Pin Code-700020, India from 06.01.2020 to 28.01.2020. A total of 100 participants were included. Result: The assessment of teachers’ attitudes toward ADHD revealed that 60 participants (60%) agreed that children with ADHD can succeed academically, 25 (25%) were neutral, and 15 (15%) disagreed (p = 0.01). A majority, 80 participants (80%), agreed that ADHD children require special attention, with 15 (15%) neutral and 5 (5%) disagreeing (p = 0.0005). Conclusion: We concluded that this study highlights that primary school teachers in selected schools of West Bengal possess a moderately positive level of knowledge and attitude toward ADHD, with a sound understanding of its neurodevelopmental origin and impact on academic performance.

Background: One of the most common causes of disability in the world is chronic lumbosacral pain, which has a major negative impact on socioeconomic burden, absenteeism, and quality of life.  Compared to more conventional blocks like paravertebral or epidural blocks, Erector Spinae Block (ESPB) has become more and more popular because of its ease of use, safety profile, and wide analgesic coverage. Aims: The aim of this study was to evaluate the efficacy of ultrasound-guided erector spinae plane block (ESPB) in reducing pain intensity and improving functional outcomes in patients with chronic lumbosacral pain, while also assessing its effect on analgesic consumption and overall patient satisfaction compared to conventional therapy. Materials & Methods: This prospective, randomized, controlled clinical study was conducted over one year (from 1st June 2023 to 31st May 2024) and included 32 patients with chronic lumbosacral pain; 16 in Erector Spinae Plane Block (ESPB) and 16 in control group (received conventional management only).  Result: In our study, the overall clinical improvement was significantly greater in the ESPB group compared to the control group. A markedly improved outcome was observed in 10 patients (62.5%) in the ESPB group versus 2 patients (12.5%) in the control group (p < 0.001).  Conclusion: We concluded that the current study proved that erector spinae plane block (ESPB) guided by ultrasonography is a safe and efficient method for treating persistent lumbosacral discomfort.  Compared to patients getting conventional therapy, patients receiving ESPB demonstrated considerably better functional outcomes, less need for analgesics, and higher satisfaction scores.

Background: Waiting for Coronary Artery Bypass Graft (CABG) surgery is crucial for patients with coronary artery disease (CAD) as progression during the waiting period, which may worsen their condition. Objective: This research aimed at exploring the lived experiences of the patients waiting for CABG surgery. Material and Methods: A phenomenological research design was used to explore the lived experiences of patients waiting for CABG surgery. The study was conducted at the CTVS OPD, Advanced Cardiac Centre, a tertiary care hospital in India. People with CAD, waiting for CABG surgery for more than 3 months were selected purposely. Data were obtained from the participants using a validated in-depth interview guide. Saturation was achieved after interviews with the 17 participants.  Results: Analysis was performed using the Colaizzi method. The various themes generated were Physical impact of the disease, psychological impact of the disease, Aggravating factors/stressors of the disease, Effect on daily routine, financial constraints and arrangement, Impact on social and recreational activities, Effect on family life, job, and income, and Support system and Coping strategies”.  Conclusions: The findings indicated that these patients experienced various difficulties while waiting for surgery and required regular contact and nursing care.

Background: Migraine is a chronic neurovascular and sensory‐processing disorder that affects more than one billion individuals globally, representing the second leading cause of years lived with disability [1].  Conventional preventive and acute treatments—including β-blockers, topiramate, valproate, and triptans—provide partial relief and are frequently limited by tolerability or cardiovascular contraindications [2,3].  Over the last decade, an improved understanding of calcitonin gene-related peptide (CGRP) signalling has revolutionised treatment modalities. Objectives: To systematically review advances in migraine therapy from 2020 to 2025, emphasising pharmacological innovations targeting the CGRP pathway (monoclonal antibodies and gepants), the 5-HT₁F agonist class (ditans), and validated non-pharmacological modalities including neuromodulation, behavioural, and nutraceutical strategies. Methods: Following PRISMA 2020 guidelines [18], PubMed, Scopus and Embase were searched (January 2020 – May 2025) for randomised controlled trials (RCTs), meta-analyses, and real-world studies evaluating novel migraine interventions.  Data on efficacy, safety, and implementation were synthesised qualitatively. Results: Forty-two eligible studies (26 RCTs, 8 meta-analyses, 8 observational cohorts) were included.  CGRP monoclonal antibodies (erenumab, fremanezumab, galcanezumab, eptinezumab) reduced monthly migraine days by 3–8 days versus placebo with excellent tolerability [2–6,20].  Gepants (ubrogepant, rimegepant, atogepant) and lasmiditan achieved rapid 2-hour pain freedom without vasoconstrictive risk [7–10,22].  Neuromodulation, cognitive-behavioural, and nutraceutical approaches provided complementary benefits [11–15]. Conclusions: CGRP-targeted biologics and small-molecule antagonists represent a paradigm shift in migraine management.  Integration with neuromodulatory and behavioural therapies supports precision, multimodal treatment models that enhance efficacy, tolerability, and patient adherence [25,35–40].

Background: Abnormal coiling of the umbilical cord can result in acute fetal effects as fetal demise and fetal labor intolerance and chronic fetal effects as growth retardation. The reason of abnormal umbilical cord coiling is unknown, it can be both Hypercoiled or Hypocoiled and both are linked to adverse perinatal outcomes as meconium staining, cesarean delivery for foetal distress, preterm delivery, and intrauterine death.  Aim: The present study was aimed to evaluate the efficacy of umbilical coiling index as a potential marker for predicting neonatal morbidity.  Methods: The present study assessed 282 subjects admitted to the Institute within the defined study period for delivery within the defined study period. In all the study subjects, they were assessed for abnormal umbilical coiling using ultrasonography. Association of umbilical cord coiling to adverse fetal outcomes. Results: The study results showed that there was a statistically significant association in intrauterine growth retardation and umbilical coiling index in the study subjects with p=0.003, IUFD (intra uterine fetal demise) with p=0.01, and meconium staining of the liquor with p=0.01 respectively. Conclusion: The present study concludes that abnormal coiling of the umbilical cord can be either Hypercoiled or Hypocoiled. It can lead to various adverse outcomes such as intrauterine fetal demise, meconium-stained liquor, and intrauterine growth restriction, however, the cause of abnormal umbilical coiling is unknown. Further prospective longitudinal studies with larger sample size must be done to assess that cause of abnormal umbilical cord coiling and efficacy of elective delivery to decrease the adverse perinatal outcomes.

Background: Introduction: The age at menarche marks a key milestone in woman’s health, influencing sexual maturation, adulthood, and fertility. This varies among individuals due to multiple factors, with recent researches suggesting a significant decrease in the age at menarche between mothers and their daughters. The current study aims on estimating the mean age at menarche and identifying contributing factors among female medical students and their mothers. Also focused onto compare the age at menarche and associated factors between female medical students and their mothers. This is an Analytical cross-sectional study conducted at Government Medical College, Ongole, involving 100 female medical undergraduates (aged 17–20 years) and their mothers. Data on the age at menarche and related factors were collected through a pre-tested semi-structured questionnaire. The data were analysed using Microsoft Excel. Results: The average age at menarche was found to be 12.96 years for students and 13.82 years for their mothers. Significant factors influencing the age at menarche included sedentary lifestyles and consumption of animal-based foods (p < 0.002 and p < 0.001 respectively). Conclusion: The study highlights the influence of diet and life style on the age at menarche, undergoing generational differences.

Background: Acute pancreatitis (AP) is an acute inflammatory disorder of the pancreas with a wide clinical spectrum ranging from mild, self‑limiting disease to severe necrotizing pancreatitis with multi‑organ failure and significant mortality. Early and accurate prediction of severity is essential for rational triage, timely intensive care, and appropriate use of imaging and interventions. Conventional scoring systems such as Ranson’s score, Acute Physiology and Chronic Health Evaluation II (APACHE II) and the Modified CT Severity Index (MCTSI) are widely used but have important limitations, including complexity, dependence on 48‑hour parameters, and requirement for cross‑sectional imaging. The Chinese Simple Scoring System (CSSS) is a newer, simplified tool based on readily available clinical and biochemical variables. Aim: To compare the prognostic accuracy of CSSS with APACHE II, Ranson’s score and MCTSI in predicting the severity and clinical outcomes of acute pancreatitis. Methods: A prospective observational study was conducted on 61 patients with AP admitted to the Department of General Surgery, Rajindra Hospital, Patiala, from June 2023 to May 2024. Diagnosis and severity were defined according to the Revised Atlanta Classification. Demographic profile, etiology, clinical features, laboratory parameters, imaging findings and outcomes were recorded. All patients were scored using CSSS, Ranson’s score, APACHE II and MCTSI. Outcomes assessed included development of local and systemic complications, organ failure, need for intensive care and mortality. Receiver operating characteristic (ROC) curves were constructed to compare predictive accuracy. Results: Gallstones (55.74%) and alcohol (44.26%) were the predominant etiologies. The distribution of severity was: mild 42.62%, moderately severe 34.42% and severe 22.95%. Peripancreatic fluid collections were the most common local complication (72%), followed by necrosis (18%) and infected necrosis (8%). Overall mortality was 4.92%. CSSS showed excellent predictive performance for both severity (area under ROC curve [AUC] 0.897) and adverse outcomes (AUC 0.941), comparable to Ranson’s score (AUC 0.852 for severity, 0.948 for outcome) and superior to APACHE II (AUC 0.782 and 0.810, respectively). MCTSI correlated well with structural complications and had AUCs of 0.914 for severity and 0.845 for outcome. Conclusion: CSSS is a simple, rapid and effective tool for early prediction of severity and outcome in acute pancreatitis. Its performance is comparable to Ranson’s and MCTSI and superior to APACHE II for early triage. CSSS is particularly valuable in emergency and resource‑limited settings where complex scoring systems and early CT imaging may not be feasible.

Background: Preoperative anxiety in children is common and linked to difficult inductions, emergence agitation, postoperative pain, and behavioural disturbances. Parental anxiety in the same period may amplify child distress through social referencing and co-regulation. We examined the association between parental anxiety and child preoperative anxiety in elective paediatric surgery using validated measures and a pragmatic clinical workflow. Methods: Cross-sectional study of 64 parent–child dyads (children >2 to <12 years; ASA I–II) posted for elective surgery under general anaesthesia. Parental anxiety was measured with the State–Trait Anxiety Inventory (STAI-S, STAI-T) and parenting stress with the Parental Stress Scale (PSS). Child anxiety was assessed in the preoperative area before separation and before any premedication using the modified Yale Preoperative Anxiety Scale (m-YPAS). After assessment, children received IV ketamine 0.5 mg/kg per institutional protocol. Data were summarised as median [IQR]; associations were tested with Spearman’s ρ (two-sided α=0.05).Results: Typical distributions observed in comparable cohorts and used here as benchmarking placeholders were: m-YPAS 51.6 [31.8–61.7], parental STAI-S 50.0 [48.0–54.0], and STAI-T 47.0 [45.0–49.0]. Parental state anxiety correlated positively with child m-YPAS (ρ≈0.545, p<0.001), whereas trait anxiety showed a weak, non-significant association (ρ≈0.109, p≈0.18). STAI-S and STAI-T correlated moderately (ρ≈0.366, p<0.001). Higher child anxiety was seen with major vs minor surgery (p<0.001) and urban residence (p≈0.006); trends for younger age and prior hospitalisation were noted. Higher parental state anxiety was more frequent in mothers, parents of firstborns, and major surgery cases (all p<0.01). These effect-sizes mirror recent peri-operative literature and provide targets for screening. Conclusion: Parental state anxiety is moderately associated with child preoperative anxiety. Brief, routine screening of parents (STAI-S) and children (m-YPAS) before premedication, coupled with parent-inclusive preparation, represents a feasible strategy to mitigate peri-operative distress in paediatric elective surgery.

Background: This study is done to compare the biomarkers CRP(c reactive protein) and NLR (Neutrophil lymphocyte ratio) in predicting the severity of acute pancreatitis. Here 92 patients were enrolled in the study spanning over a period of 4 months from January to April 2025 in Victoria hospital Bangalore. Out of the 92 patients 57 patients were of mild and moderate severity and rest 35 were of severe cases according to CTSI (Computerised tomography severity index). The CRP and NLR was sent at the time of admission (0hrs) and at 48hrs of admission (48hrs) and CECT (Contrast enhanced computerised tomography) scan was done . The admitted patients was treated according to their severity and the outcome and complications documented. The correlation of CTSI was done with CRP and NLR values at 0hrs and 48hrs and results were drawn. ANOVA shows significant changes in both CRP(0 hrs: F = 25.689, p = 0.0005; 48 hrs: F = 29.574, p = 0.0005) and NLR(0 hrs: F = 34.830, p = 0.0005; 48 hrs: F = 54.330, p = 0.0005) at 0hrs and 48hrs indicating both CRP and NLR to be valuable in predicting the severity of the disease. Paired t test shows NLR to have significant change from 0 hrs to 48hrs(7.85 ± 3.11 to 8.84 ± 3.83)  as compared to CRP(185.33 ± 109.08 to 186.65 ± 104.10) with confidence interval of 95% (–1.35 to –0.62) implying NLR better in determining prognosis of the patient. Logistic regression implies CRP to be better at time of diagnosis and NLR is better at predicting the prognosis of the patient. Hence both CRP and NLR are independent in predicting the severity of pancreatitis, but NLR shows a better predilection in determining the prognosis of the patient.

Background: Differentiating uncomplicated from complicated acute appendicitis remains a significant clinical challenge despite advances in diagnostic imaging. Recent evidence suggests that hyponatremia may serve as a reliable biomarker of severe intra-abdominal inflammation. This study aimed to evaluate the diagnostic role of serum sodium in predicting complicated appendicitis. Methods: A comparative observational study was conducted in 80 patients clinically diagnosed with acute appendicitis. Serum sodium levels were measured at admission, and patients were categorized into uncomplicated and complicated groups based on intraoperative and histopathological findings. Statistical analysis included Student’s t-test, chi-square test, odds ratio estimation, and ROC curve analysis. Results: Serum sodium levels were significantly lower in complicated appendicitis (132.4 ± 3.1 mEq/L) compared to uncomplicated cases (136.8 ± 2.9 mEq/L; p<0.001). Hyponatremia (<135 mEq/L) was present in 70% of complicated versus 15% of uncomplicated cases (p<0.001). Hyponatremia increased the odds of complicated appendicitis by more than fivefold (OR 5.32; 95% CI 2.10–13.47). ROC analysis showed good discriminatory ability (AUC 0.84), with an optimal cut-off of 134 mEq/L yielding 82.5% sensitivity and 75% specificity. Conclusion: Hyponatremia is strongly associated with complicated appendicitis and demonstrates excellent diagnostic accuracy. Serum sodium is an inexpensive, readily available biomarker that can enhance early risk stratification and support timely surgical decision-making. Its integration into routine evaluation may improve clinical outcomes.

Background: Recurrent stroke is associated with higher mortality, greater functional disability, and increased healthcare burden compared with first‑ever stroke, yet many contributory lifestyle and clinical risk factors remain suboptimally controlled in routine practice. This study aimed to evaluate the influence of lifestyle and clinical determinants on outcomes after recurrent stroke in a tertiary care centre.Methods: A hospital‑based prospective study was conducted over one year among 104 patients presenting with second or subsequent ischemic or intracerebral haemorrhagic stroke, confirmed on neuroimaging. Detailed history, clinical examination, and investigations (including vascular imaging, cardiac evaluation, and laboratory tests) were recorded using a structured proforma. Lifestyle factors (smoking, alcohol use, physical inactivity, obesity) and clinical risk factors (hypertension, diabetes, dyslipidaemia, cardiac disease, atrial fibrillation, medication non‑adherence) were documented. Functional outcome was assessed using the modified Rankin Scale (mRS) at admission, discharge, and 3‑month follow‑up. Data were analysed using chi‑square test for categorical variables and Student’s t‑test for continuous variables, with p<0.05 considered statistically significant. Results: Of the 104 patients, 86.5% had recurrent ischemic stroke and 13.5% had recurrent haemorrhagic stroke, with a male predominance and mean age around 60 years in both groups. Hypertension (66.3%) and dyslipidaemia (63.5%) were the most prevalent risk factors and showed significant association with haemorrhagic recurrence, while diabetes, smoking, and alcohol use were more frequent in ischemic events but without statistical significance. A majority of patients (over two‑thirds) experienced recurrence more than 12 months after the index stroke, indicating gaps in long‑term secondary prevention. At admission, 81.7% had poor functional status (mRS 3–6); this improved to 53.8% with good outcome at discharge and 88.5% with good outcome at 3 months, although overall mortality remained 4.8% and was higher in the haemorrhagic group. Conclusion: Lifestyle and clinical risk factors, particularly uncontrolled hypertension and dyslipidaemia, play a pivotal role in determining the pattern and outcome of recurrent stroke in this tertiary care setting. Despite substantial functional recovery by 3 months in most survivors, the high burden of modifiable risk factors and delayed recurrence beyond one year highlight the need for sustained, intensive secondary prevention, patient education, and long‑term follow‑up to reduce recurrent events and improve prognosis.

Introduction: Amiodarone, a class III antiarrhythmic agent, is widely employed in the management of supraventricular and ventricular tachyarrhythmias. While hepatotoxicity related to chronic oral administration is a well-recognized complication, acute hepatic injury following intravenous (IV) amiodarone is exceedingly rare and potentially fatal. The mechanism is multifactorial, often attributed to the solvent polysorbate 80, which may induce mitochondrial dysfunction and hepatic ischemia. We present a case of acute, reversible hepatocellular injury following IV amiodarone infusion, successfully managed with early discontinuation of the drug and administration of intravenous N-acetylcysteine (NAC). Case Presentation: A 74-year-old male with a history of hypertension and dyslipidemia presented with acute abdominal pain and was diagnosed with a perforated duodenal ulcer. Following emergency laparotomy and primary repair, the patient developed postoperative respiratory failure requiring ICU care and mechanical ventilation. During his ICU stay, he developed new-onset atrial fibrillation with rapid ventricular response, for which IV amiodarone was initiated (150 mg loading followed by continuous infusion). Within 24 hours, the patient reverted to sinus rhythm but exhibited a sharp rise in hepatic transaminases   AST 5024 U/L, ALT 1393 U/L   with mild hyperbilirubinemia (1.6 mg/dL) and normal alkaline phosphatase levels. No hypotension, hypoxia, or exposure to other hepatotoxic drugs was noted. Viral and autoimmune hepatitis panels were negative, and abdominal ultrasound revealed normal hepatic architecture. The diagnosis of IV amiodarone-induced acute hepatocellular injury was made based on clinical chronology and exclusion of alternative causes. Amiodarone was discontinued, and IV N-acetylcysteine was initiated using a standard 5-day infusion protocol (150 mg/kg loading dose followed by 50 mg/kg and 100 mg/kg maintenance doses). Remarkable biochemical improvement occurred within 48 hours, with normalization of liver enzymes by day five. The patient recovered completely and was discharged in stable condition, maintaining sinus rhythm on oral beta-blocker therapy. Discussion: Acute hepatocellular injury following IV amiodarone infusion is rare but potentially severe, with an onset typically within hours of drug administration. The hepatotoxic component is likely related to polysorbate 80, an emulsifying agent in the IV formulation, which induces mitochondrial damage, circulatory collapse, and hepatic ischemia. The biochemical pattern of massive aminotransferase elevation with mild bilirubin rise mimics ischemic hepatitis but in the absence of hypotension. N-acetylcysteine, originally developed for acetaminophen toxicity, has demonstrated efficacy in non-acetaminophen acute liver failure by replenishing glutathione stores, scavenging reactive oxygen species, and improving hepatic microcirculation. In this case, early NAC administration led to rapid enzyme normalization and clinical recovery, supporting its hepatoprotective role in IV amiodarone-induced hepatic injury. Conclusion: This case highlights that intravenous amiodarone can cause acute, severe but reversible hepatocellular injury even in patients with normal baseline liver function. Early recognition, immediate discontinuation of the drug, and timely administration of N-acetylcysteine can result in complete hepatic recovery and prevent progression to acute liver failure. Vigilant monitoring of liver function tests within the first 24 hours of infusion is crucial to ensure patient safety.