International Journal of Advances in Medicine

Seeing the way through – VividTrac in successful intubation of a neonate with VACTERL anomaly: a case report

2026-08-20T19:50:07+0530

Airway management in neonates is challenging due to anatomical and physiological factors, and the presence of congenital anomalies such as VACTERL association further increases the risk of difficult intubation. We report a case of a 3-day-old late preterm male neonate weighing 2.8 kg, antenatally diagnosed with anal atresia and associated cardiac and renal anomalies, posted for high pelvic colostomy. Anticipating a difficult airway and perioperative instability, tracheal intubation was performed using the VividTrac video laryngoscope. The device provided an excellent glottic view and enabled successful first-attempt intubation with a 3.0 mm uncuffed endotracheal tube, while maintaining oxygen saturation above 95%. Anaesthesia and intraoperative hemodynamics remained stable, and the neonate was transferred postoperatively to the neonatal intensive care unit for further care. This case highlights the usefulness of VividTrac video laryngoscopy in securing the airway safely and efficiently in neonates with suspected VACTERL anomaly, emphasising its role in reducing anaesthetic complications in high-risk neonatal airways.

Recurrent seizures in non-diabetic patient presenting with hypoglycemia: an eye opener for clinicians

2026-08-20T19:50:06+0530

Seizures represent transient episodes of abnormal, excessive, and synchronized electrical discharges of neurons in the brain that may be associated with various structural, metabolic, infectious, toxic, autoimmune, or genetic conditions. Metabolic disorders also include hypoglycemia which is recognized as one of the possible seizure triggers, since reduced glucose levels hinder energy metabolism in the brain resulting in neuronal dysfunction and hyperexcitability. Therefore, estimation of blood glucose should be included in the initial approach when dealing with patients experiencing acute seizures. The opposite condition-hypoglycemia caused by seizures-is very uncommon but still exists. Despite the fact that the decrease in blood glucose may appear after prolonged generalized tonic-clonic seizures as a result of increased glucose uptake by the brain and muscles, recurrent hypoglycemia after seizure termination is quite rare, especially in the absence of diabetes mellitus. Potential mechanisms of hypoglycemia development in such cases are related to increased metabolic needs during the seizure, decreased glycogen storage in the liver, decreased gluconeogenesis and in rare cases, exaggerated insulin production.

Eosinophilic esophagitis: not rare, simply under-biopsied-experience from a tertiary centre in South India

2026-08-20T19:49:18+0530

Eosinophilic esophagitis (EoE) is considered rare in India, yet this perception likely reflects diagnostic omission rather than true epidemiological rarity. We report two cases of EoE diagnosed within a two-month period at a tertiary gastroenterology centre in Bengaluru, South India, from among ten consecutive patients in whom targeted esophageal biopsies were obtained on clinical suspicion-a diagnostic yield of 20%. The first patient was a 54-year-old woman with longstanding proton pump inhibitor refractory dysphagia, chest pain, and regurgitation, whose prior endoscopy had attributed findings to reflux disease without esophageal biopsy. Repeat evaluation revealed mucosal rings with exudates and a peak intraepithelial eosinophil count of 25 per high-power field. She responded completely to vonoprazan and swallowed budesonide. The second was a 37-year-old man presenting with progressive dysphagia and weight loss, with an endoscopic reference score of 7 and a peak eosinophil count of 30-35 per high-power field, who improved on a six-food elimination diet. These cases highlight that co-existent erosive esophagitis may mask EoE endoscopically, and that a protocol-driven biopsy approach is essential to unmask its true prevalence in India.

Paraquat poisoning: a grim prognosis and urgent need for policy action – a case series

2026-08-20T19:49:23+0530

Paraquat is a highly toxic, rapidly acting, non-selective herbicide with widespread use in India despite being banned in many countries. It is associated with a high mortality rate and lacks a specific antidote. Aim and objective were to present a case series of paraquat poisoning, highlighting clinical presentation, complications, treatment modalities, and outcomes. Emphasizing the importance of referral of patients to centers with facilities where lifesaving treatment like renal replacement therapy (haemodialysis, hemoperfusion, continuous Veno-venous hemofiltration) can be done on time to reduce the high mortality rate associated with it. Retrospective chart review of 10 patients admitted with paraquat poisoning at AIIMS Bhopal between March 2022 and March 2023. All patients presented 2-22 days post-ingestion, with amounts ranging from 10-100 ml. Common features included oral and gastrointestinal ulcers, hepatitis, acute kidney injury (AKI), and acute respiratory distress syndrome (ARDS). Hemodialysis was performed in two patients presenting within 3 days. Despite supportive therapy (steroids, N-acetylcysteine, renal replacement therapy), mortality was 100%, with ARDS being the universal cause of death. Paraquat poisoning carries a dismal prognosis with no survivors in our cohort. Early referral to tertiary care centers and timely initiation of renal replacement therapy may improve outcomes. Urgent public health measures and consideration of a ban are warranted.

Cost implications of prolonged lumbar spine surgery at National Orthopaedic Hospital Dala Kano, Nigeria

2026-08-20T19:50:04+0530

Background: Prolonged operative time is associated with increased morbidity and resource utilization in spine surgery. However, the cost implications of prolonged lumbar spine surgery in low‑resource Nigerian settings have not been quantified. This study compared direct costs between patients with operative time ≤2 hours and those >2 hours for lumbar decompression and stabilisation.

Methods: A retrospective cohort study of 82 consecutive patients who underwent elective L2-L5 decompression and pedicle screw stabilisation at National Orthopaedic Hospital Dala, Kano, between January 2023 and December 2025 was conducted. Patients were divided into two groups: Group A (operative time ≤120 minutes, n=35) and group B (operative time >120 minutes, n=47). Direct costs (personnel, consumables, implants, operating theatre time, anaesthesia, postoperative care) were calculated from hospital billing records. Outcomes included total cost, length of stay, and complication rates.

Results: The mean operative time was 98±15 minutes in Group A and 175±28 minutes in Group B (p<0.001). Total direct cost per patient was significantly higher in Group B: ₦ 1,245,000 (US$ 2,718) vs ₦ 875,000 (US$ 1,910) in Group A (p<0.001). The excess cost attributable to prolonged surgery was ₦370,000 (US$808) per patient. Prolonged surgery was associated with longer hospital stay (8.4±2.2 vs 5.6±1.5 days, p<0.001) and higher complication rates (23.4% vs 8.6%, p=0.04). Multivariate analysis identified operative time >2 hours as an independent predictor of increased total cost (β=0.52, p<0.001) after adjusting for age and comorbidity.

Conclusions: Prolonged lumbar spine surgery (>2 hours) is associated with significantly higher direct costs, longer hospital stay, and increased complications. Strategies to reduce operative time-including surgeon training, team optimisation, and implant standardisation-could generate substantial cost savings in resource‑limited settings.

Physician perspectives on spacer device usage, prescription patterns and clinical decision-making factors in the management of respiratory conditions: a nationwide, multicenter cross-sectional observational study

2026-07-05T08:22:07+0530

Background: Pressurized metered-dose inhalers (pMDIs) are widely used for delivering bronchodilators and corticosteroids; however, their effectiveness is often compromised by poor inhalation techniques, leading to inadequate drug deposition in the lungs and suboptimal disease control. Spacer devices, including valved holding chambers (VHCs), are designed to overcome these challenges by improving aerosol delivery, reducing oropharyngeal deposition, and enhancing treatment adherence in patients with respiratory conditions. This survey aimed to assess physicians’ perspectives on the usage, prescription patterns, and decision-making factors associated with spacer devices in respiratory conditions.

Methods: A cross-sectional survey was conducted among qualified medical practitioners using a structured questionnaire. Data on demographics, indications, and perceptions regarding spacer use were collected from 6,787 respondents.

Results: Chest physicians constituted the largest respondent group (n=3,261). Nearly 80% of clinicians reported frequently or occasionally recommending spacer devices. Spacer use was most commonly associated with asthma maintenance therapy (n=5,214), acute asthma (n=3,861), and chronic obstructive pulmonary disease (COPD) (n=4,460). Key factors influencing prescription included disease severity, patient age, and the patient’s ability to use inhalers correctly. Major barriers identified were lack of patient/caregiver awareness, poor inhaler technique, and high device cost. Most respondents considered spacers more effective than nebulizers, and cylindrical spacers were the preferred design.

Conclusions: The findings demonstrate widespread acceptance of spacer devices in respiratory care, particularly in asthma and COPD management. However, gaps in patient education, inhaler technique, and accessibility remain important barriers, highlighting the need for improved awareness initiatives and user-friendly spacer designs to optimize treatment outcomes.

Neutrophil, lymphocyte and platelet ratio as a predictor of acute kidney injury after major noncardiac surgery

2026-08-20T19:49:21+0530

Background: Acute kidney injury (AKI) is a common complication after major surgery associated with increased morbidity and mortality. Inflammation plays a key role in the pathogenesis of postoperative AKI. This study evaluated the neutrophil-lymphocyte-platelet ratio (NLPR) as a predictor of AKI after major noncardiac surgery.

Methods: In a retrospective analysis, we studied 300 patients who underwent major noncardiac surgery. The NLPR was calculated from the complete blood count obtained within 12 hours postoperatively. AKI was defined by the KDIGO criteria. Multivariable logistic regression was used to evaluate the association between NLPR and AKI.

Results: AKI occurred in 46 patients (15.3%). The mean NLPR was significantly higher in patients who developed AKI compared to those who did not. On multivariable analysis, NLPR remained an independent predictor of AKI. The area under the receiver operating characteristic curve for NLPR to predict AKI was 0.804.

Conclusions: The neutrophil-lymphocyte-platelet ratio is an independent predictor of acute kidney injury after major noncardiac surgery. This simple, widely available biomarker can help identify patients at high risk for this complication.

Rosuvastatin use in contemporary clinical practice: insights from a physician survey on lipid management and cardiovascular risk reduction

2026-07-14T06:59:42+0530

Background: Contemporary lipid management guidelines advocate increasingly stringent low-density lipoprotein cholesterol (LDL-C) targets and earlier treatment intensification in patients at elevated cardiovascular risk. Rosuvastatin remains a widely prescribed statin owing to its potent LDL-C-lowering efficacy; however, real-world prescribing practices and treatment preferences continue to evolve with expanding use of combination lipid-lowering strategies. Objectives were to evaluate contemporary physician perspectives and prescribing practices related to rosuvastatin use across the cardiovascular risk continuum and assess alignment with current guideline recommendations.

Methods: A cross-sectional, questionnaire-based survey was conducted among 91 clinicians involved in cardiovascular risk management. The survey assessed rosuvastatin prescribing patterns, dose selection, combination therapy utilization, LDL-C treatment goals, treatment intensification strategies, lipid monitoring practices, post-percutaneous coronary intervention (PCI) lipid management, and integration of lipid-lowering and antiplatelet therapies. Data were analyzed using descriptive statistics and reported as percentages.

Results: Rosuvastatin monotherapy was preferred by 85.4% of clinicians in primary prevention, with rosuvastatin 10 mg being the most frequently prescribed dose (56.1%). Combination therapy use increased with cardiovascular risk, and 62.2% of clinicians preferred combination regimens in secondary prevention. Rosuvastatin plus ezetimibe was the most commonly selected lipid-lowering combination, while rosuvastatin plus aspirin plus clopidogrel was the preferred secondary prevention regimen (44.8%). LDL-C target attainment was the primary driver of treatment intensification, with 55.6% of clinicians targeting LDL-C<70 mg/dl and 44.4% pursuing more aggressive targets. Among high- and very-high-risk ASCVD patients and post-PCI populations, rosuvastatin 40 mg plus ezetimibe 10 mg was the most frequently preferred intensive lipid-lowering strategy. LDL-C remained the primary monitoring parameter, although ApoB and non-HDL-C were increasingly utilized.

Conclusions: Rosuvastatin remains the preferred foundation of lipid-lowering therapy in contemporary clinical practice. Increasing adoption of LDL-C goal-directed treatment intensification, ezetimibe-based combination therapy, prolonged post-PCI lipid management, and integration of lipid-lowering with antiplatelet strategies reflects growing alignment of real-world practice with current evidence-based guideline recommendations.

Ultrasound-guided popliteal block for foot and ankle surgery: a prospective observational study of clinical outcomes and patient satisfaction

2026-07-17T09:24:16+0530

Background: Regional anaesthesia has become an integral component of modern perioperative care owing to its ability to provide superior postoperative analgesia while reducing opioid consumption and avoiding the physiological perturbations associated with general anaesthesia. Ultrasound-guided popliteal block has emerged as an effective technique for surgeries involving the foot and ankle, offering precise localisation of neural structures and improved procedural success. However, clinical data evaluating its effectiveness in the Indian population remain limited. Aim was to evaluate the clinical efficacy, safety, block characteristics, postoperative analgesia, and patient satisfaction associated with ultrasound-guided popliteal block as the primary anaesthetic technique for foot and ankle surgery.

Methods: A prospective observational study was conducted in 60 adult patients (ASA physical status I to III) undergoing elective or emergency foot and ankle surgery. Ultrasound-guided popliteal sciatic nerve block was performed using a mixture of 10 ml of 1.5% lignocaine and 5 ml of 0.5% bupivacaine. Procedural time, onset and duration of sensory and motor blockade, duration of postoperative analgesia, haemodynamic variables, block success, complications, and patient satisfaction were recorded and analysed.

Results: The mean procedure time was 4.1±1.3 minutes. Sensory blockade occurred after 3.1±1.0 minutes, while motor blockade developed after 7.0±1.3 minutes. Mean duration of sensory blockade was 183±14.8 minutes and motor blockade lasted 144.3±13.3 minutes. The first postoperative complaint of pain occurred after 239.0±21.6 minutes. Haemodynamic parameters remained stable throughout the perioperative period. Only one block required conversion to general anaesthesia, resulting in an overall success rate of 96.7%. No procedure-related complications were observed, and all remaining patients reported high satisfaction with the anaesthetic technique.

Conclusions: Ultrasound-guided popliteal sciatic nerve block is a safe, reliable, and effective primary anaesthetic technique for foot and ankle surgery. It provides rapid onset, prolonged postoperative analgesia, excellent patient satisfaction, and minimal complications. Wider adoption of this technique may contribute to enhanced recovery protocols and reduced perioperative opioid requirements.

Clinician perspectives on cefpodoxime use in respiratory tract infections in India: results from a nationwide survey

2026-08-20T19:49:23+0530

Background: Despite several clinical studies regarding the effectiveness of cefpodoxime in various infections, there is a dearth of studies among clinicians. So, this study aims to assess the perspectives of clinicians on the clinical use and perceived outcomes of cefpodoxime in respiratory tract infections (RTIs) in India.

Methods: A cross-sectional study was conducted among clinicians practicing in routine clinical settings across India. A 22-question structured questionnaire was used to assess respiratory infection management, with a focus on cefpodoxime use, etiology, diagnostic approaches and clinical outcomes. Descriptive statistics were used to summarize responses as frequencies and percentages using Microsoft Excel.

Results: Among 818 clinicians, 51% reported that lower RTIs (LRTIs) are the most commonly encountered infections in their clinical practice. More than half (58.92%) indicated prescribing cefpodoxime primarily for LRTIs. About 59% of respondents stated that both bacterial and viral etiologies contribute to upper RTIs (URTIs) in their practice. Around 53% identified chest X-ray as the most preferred diagnostic modality for Mycoplasma pneumoniae infection in adults. The majority (75.67%) reported cefpodoxime as the most commonly used antimicrobial agent for URTIs. A large proportion (85.82%) indicated cefpodoxime as the preferred oral drug for acute otitis media. Approximately 51% rated cefpodoxime as providing marked improvement on a 5-point global improvement scale.

Conclusions: LRTIs are most prevalent in clinical practice, with cefpodoxime widely used across respiratory indications. Clinicians recognize mixed etiologies in URTIs and prefer chest X-ray for diagnosis. Cefpodoxime demonstrates high usage, favorable outcomes and marked clinical improvement, supporting its effectiveness and utility in routine RTI management.

Association of serum magnesium levels with microvascular complications in type 2 diabetes mellitus, with significant correlation to diabetic retinopathy: a cross-sectional study

2026-08-20T19:49:22+0530

Background: Magnesium is essential for numerous biological processes, including glucose metabolism, insulin responsiveness and vascular integrity. A deficiency in magnesium is commonly reported in individuals with type 2 diabetes mellitus (T2DM) and is suspected to contribute to the development of microvascular complications such as nephropathy, retinopathy and neuropathy. This study aimed to evaluate the prevalence of hypomagnesemia in T2DM patients and explore its association with microvascular complications.

Methods: A cross-sectional, observational study was conducted at SRN Hospital, Prayagraj, involving 143 patients diagnosed with T2DM. Serum magnesium levels were estimated, with values below 1.7 mg/dl considered indicative of hypomagnesemia. Statistical analysis was used to examine relationships between magnesium levels and the occurrence of microvascular complications as nephropathy, retinopathy and neuropathy.

Results: Among the 143 participants (average age 57 years), hypomagnesemia was identified in 17.5% of cases. The overall mean serum magnesium concentration was 1.93±0.29 mg/dl. A significant inverse relationship was observed between serum magnesium levels and the presence of diabetic retinopathy (p=0.008); retinopathy was found in 60% of patients with hypomagnesemia compared to 29.66% of those with normal magnesium levels. Although nephropathy and neuropathy were more prevalent in the hypomagnesemia group (40% and 28%, respectively), these associations were not statistically significant.

Conclusions: The study found a significant link between magnesium deficiency and diabetic retinopathy, highlighting a potential role of hypomagnesemia in its pathogenesis. Regular monitoring of magnesium status in T2DM patients may help identify those at higher risk for microvascular complications.

Acute kidney injury in patients with malignancy: clinical characteristics, etiology and outcomes across KDIGO stages

2026-08-20T19:50:05+0530

Background: Acute kidney injury (AKI) is a frequent and serious complication in patients with malignancy, contributing to increased morbidity, mortality and adverse renal outcomes. This study evaluated the clinical profile, primary etiologies, laboratory characteristics and outcomes of oncology patients with AKI according to kidney disease. Improving global outcomes (KDIGO) staging.

Methods: This retrospective observational study included 100 adult oncology patients with KDIGO-defined AKI admitted between May 2021 and April 2026. Patients were classified as KDIGO stage 1 (n=30), stage 2 (n=35) or stage 3 (n=35). Demographic characteristics, comorbidities, primary etiologies, laboratory parameters and clinical outcomes were compared across AKI stages.

Results: Increasing AKI severity was associated with older age and a higher prevalence of diabetes mellitus, hypertension and hematological malignancies. Sepsis was the most common primary etiology of AKI across all stages. Progressive worsening of hematological, inflammatory, metabolic and biochemical parameters was observed with increasing KDIGO stage (all p<0.001). Complete renal recovery at discharge declined significantly from 83.3% in stage 1 to 20.0% in stage 3, while in-hospital mortality increased from 10.0% to 51.4% (p=0.001). Among hospital survivors, complete recovery at 3 months decreased from 88.9% to 29.4%, whereas progression to chronic kidney disease increased from 7.4% to 52.9% across stages 1 to 3 (both p<0.001). Hospital readmission was more frequent in patients with severe AKI (p=0.048).

Conclusions: Higher KDIGO stage is associated with greater clinical and biochemical derangement, reduced renal recovery, increased CKD progression and higher mortality in oncology patients with AKI. Early recognition and timely intervention may improve renal and patient outcomes in this high-risk population.

Magnetic resonance imaging‑based preoperative planning of pedicle screw length in traumatic lumbar spine injuries: a prospective study in a resource‑limited setting

2026-08-20T19:49:19+0530

Background: Accurate preoperative determination of pedicle screw length is essential for safe and effective spinal stabilisation in traumatic lumbar injuries. In resource‑limited settings where computed tomography (CT) may be unavailable, magnetic resonance imaging (MRI) offers a radiation‑free alternative. This prospective study evaluated the utility of MRI for predicting pedicle screw length, vertebral body purchase, and screw accuracy in traumatic lumbar spine injuries.

Methods: A prospective study was conducted at National Orthopaedic Hospital Dala, Kano, from January 2025 to December 2025. Two hundred pedicle screws (6.5 mm diameter; lengths 40 mm, 45 mm, and 50 mm) were inserted in patients with traumatic lumbar fractures (L1-L5). Preoperative MRI measured the pedicle‑vertebral body length (PVBL). Screw length was selected to achieve ≥75% vertebral body purchase. Postoperative CT assessed screw accuracy using the Gertzbein‑Robbins classification, with inter‑observer agreement calculated.

Results: Mean PVBL was 44.8±3.6 mm (range 38-54 mm), with significant variation across lumbar levels: L1 42.4±3.1 mm, L2 43.8±3.4 mm, L3 45.2±3.5 mm, L4 46.8±3.7 mm, and L5 45.6±3.9 mm. MRI‑predicted PVBL showed strong correlation with actual screw length (Pearson’s r=0.89, p<0.001). Vertebral body purchase ≥75% was achieved in 172 screws (86.0%). Screw accuracy (Gertzbein‑Robbins grades A/B) was 92.0% (184/200), with inter‑observer agreement of κ=0.87 (95% CI: 0.82-0.92). The 50 mm screws achieved the highest purchase (78.4±4.2%) but had a slightly higher breach rate (6.0%) compared with 45 mm screws (4.5%).

Conclusions: MRI‑based preoperative planning effectively predicts pedicle screw length and achieves ≥75% vertebral body purchase in 86% of traumatic lumbar injuries. The strong correlation between MRI‑predicted PVBL and actual screw length supports MRI as a viable alternative to CT in resource‑limited settings, with high screw accuracy confirmed on postoperative CT.

Evaluation of histopathological patterns in kidney disease: an overview from a tertiary health care center

2026-08-20T19:49:20+0530

Background: The clinical manifestation of renal pathologies exhibits considerable heterogeneity. The incidence of kidney diseases is not only region-specific but also varies within different locales of the same country. This study was undertaken at a tertiary care hospital in central India to know the prevalence of various kidney diseases. The lack of a comprehensive national registry in India hampers the ability to compile detailed documentation of the diverse clinical presentations and histopathological characteristics of renal conditions nationwide. Consequently, this study aims to provide a histopathological diagnosis of kidney diseases proved by biopsy results.

Methods: We collected demographic profile and native kidney biopsy reports of 154 patients who underwent kidney biopsy from January 2022 to January 2024 in the Department of Nephrology at our tertiary health care.

Results: A total of 154 native kidney biopsies were analyzed, mean age was 33.58±15.79 years. The most common clinical presentation and indication for renal biopsy was nephrotic syndrome (59.74%). Most common histological pattern was primary glomerular disease in 92 (62.33%), followed by secondary glomerular in 26 (16.88%). The leading histopathological diagnoses were FSGS (18.8%) in >18 years and MCD (33.33%) in <18 years of age. MN and IgAN in 10.38% patients.

Conclusions: The predominant indication for renal biopsy in our cohort was nephrotic syndrome. The spectrum of renal diseases varies by geographic location and is subject to temporal fluctuations. Consequently, the establishment of a renal biopsy registry is imperative for monitoring the evolving patterns of renal pathologies in India.