International Journal of Advances in Medicine

A rare complication of systemic Salmonella infection in a young boy: a case report

Shipra Gulati, Rishikesh Dessai, Kunal Chawla, Chirayu Agrawal — Mon, 05 Oct 2026 00:00:00 +0530

Salmonella spondylodiscitis is an uncommon extraintestinal manifestation of enteric fever and may closely mimic tubercular or pyogenic spinal infections in endemic settings. It typically results from hematogenous seeding of the vertebrae during or after a febrile illness and often presents with chronic back pain and raised inflammatory markers, while routine blood cultures may be non-contributory. We describe a young, otherwise healthy patient with subacute febrile back pain in whom spinal imaging showed lumbar spondylodiscitis, and image-guided vertebral biopsy established Salmonella Typhi as the etiological agent. The patient was managed successfully with prolonged, targeted intravenous antibiotics and spinal immobilization, without the need for surgical intervention. This case highlights the importance of considering Salmonella spondylodiscitis in the differential diagnosis of febrile back pain following enteric fever and underscores the pivotal role of early MRI and tissue diagnosis in guiding appropriate antimicrobial therapy and preventing long-term spinal sequelae.

A fatal case of gastric mucormycosis: a case report

Karan Kaura, Arundhati Diwan, Supriya Barsode, Komal Singh, Kunda Jagdale — Thu, 22 Oct 2026 00:00:00 +0530

Mucormycosis is an invasive infection caused by the fungi of the order Mucorales. The members of the family Mucoraceae most commonly isolated are Rhizopus and the second most common genus is Mucor. It typically affects immunocompromised individuals. Common presenting symptoms are abdominal pain, hematemesis and melena. The infection pathway is airborne through skin or ingestion of the sporangiospores. Primary gastrointestinal mucormycosis is a rare disease with a high mortality rate. We report a case of mucormycosis associated necrotic gastric ulcer with a fatal outcome. A 47-year-old female with history of chronic kidney disease presented with acute gastrointestinal symptoms. An endoscopy was performed and diagnosis of peptic ulcer disease in the setting of hemodialysis was made. Histopathology revealed mucormycosis and she was started on posaconazole. The patient was stabilized and discharged however failed to comply to antifungal treatment; resulting in a fatal outcome. Recognizing gastric mucormycosis early with timely treatment is essential for a good outcome.

Persistent hypokalemia masking distal tubular acidosis and hypothyroidism: a case report

Thu, 22 Oct 2026 00:00:00 +0530

Hypokalemic paralysis is an important reversible cause of acute flaccid weakness and may result from either intracellular potassium shift or true potassium depletion. Persistent hypokalemia associated with metabolic acidosis should be promptly evaluated for renal tubular disorders. We report a case of a 49-year-old man who presented with acute progressive quadriparesis and severe hypokalemia. Initial evaluation revealed serum potassium level of 1.5 mmol/l, metabolic acidosis, elevated creatine phosphokinase, renal potassium wasting, hypocalcemia with secondary hyperparathyroidism, and hypothyroidism. Despite potassium replacement, the patient demonstrated persistent hypokalemia ranging from 2.0-3.0 mmol/l and low serum bicarbonate levels across four months of outpatient follow-up. Urine studies and persistent acid-base abnormalities suggested an underlying distal renal tubular dysfunction. The patient improved clinically with potassium supplementation, supportive management with ongoing clinical monitoring during follow-up. This case highlights the importance of distinguishing hypokalemic paralysis secondary to chronic renal potassium wasting from isolated hypokalemic periodic paralysis.

Adult-onset Still's disease presenting with generalized seizures in the absence of macrophage activation syndrome: a case report with review of the neurological literature

Archit Kalra, Poonam Gupta, Ajeet Kumar Chaurasia, Divya Chutani — Thu, 22 Oct 2026 00:00:00 +0530

Adult-onset Still’s disease (AOSD) is a rare systemic autoinflammatory disorder characterized by quotidian fever, arthritis, rash, and marked hyperferritinemia. Neurological manifestations are uncommon, and generalized seizures are exceptionally rare, particularly in the absence of macrophage activation syndrome (MAS). An 18-year-old man presented with one month of high-grade fever, migratory polyarthralgia, cervical and axillary lymphadenopathy, mild hepatosplenomegaly, and two generalized tonic-clonic seizures preceding diagnosis. Laboratory evaluation showed neutrophilic leukocytosis (21,300/mm³), elevated ESR and CRP, transaminitis, and serum ferritin >2,000 ng/mL. Electrolytes were normal. Blood and urine cultures, HIV testing, tuberculosis evaluation, echocardiography, thoracic CT, and lymph-node cytology were unremarkable. NCCT brain showed no structural lesion, and there was no clinical or laboratory evidence of MAS. After exclusion of infectious, autoimmune, and malignant causes, the patient fulfilled Yamaguchi criteria for AOSD. Treatment with prednisolone (1 mg/kg/day), methotrexate, and levetiracetam resulted in rapid resolution of fever and improvement in arthralgia. Generalized seizures may rarely be the presenting manifestation of AOSD even without MAS or demonstrable CNS pathology. In patients with unexplained seizures accompanied by persistent systemic inflammation and marked hyperferritinemia, AOSD should be considered after exclusion of infectious, autoimmune, and structural neurological causes; early immunosuppressive therapy is associated with favorable outcomes.

Rehabilitation challenges in a polytrauma patient with discordant neurological findings: coexistence of traumatic brachial plexus injury and bilateral ankle clonus – a case report

Bidyarani T., Bimol N., Gokul M., Puni N., Papiya P. — Thu, 22 Oct 2026 00:00:00 +0530

Traumatic brachial plexus injury (BPI) typically produces lower motor neuron (LMN) findings, whereas exaggerated reflexes and ankle clonus suggest upper motor neuron (UMN) pathway involvement. Their coexistence following polytrauma presents a diagnostic and rehabilitation challenge. A 23-year-old man sustained a road traffic accident while riding a two-wheeler, resulting in severe left upper-limb weakness and a comminuted distal femur fracture. Following open reduction and internal fixation, he was referred for rehabilitation. Examination revealed marked hypotonia, with muscle power of 1/5 in the left shoulder and elbow and 2/5 in the finger flexors and abductors. Left biceps and triceps reflexes were absent, while sensation was impaired in the C5 and C6 dermatomes. Bilateral Hoffmann signs, brisk knee jerks, and sustained ankle clonus were present. There was no definite sensory level, and bladder and bowel functions were preserved. Nerve conduction studies and electromyography suggested left brachial plexopathy with axonal involvement. Computed tomography of the brain and spine showed no acute abnormality. Spinal MRI was not obtained because of concerns regarding the femoral fixation implants. A multidisciplinary rehabilitation programme included positioning, splinting, passive mobilisation, electrical stimulation, lower-limb exercises, progressive mobilisation, transfer training, and functional retraining. Functional Independence Measure score improved from 45/126 at admission to 90/126 after one month. Upper-limb weakness persisted, while ankle clonus decreased on serial examination. This case highlights the importance of repeated neurological assessment and individualized multidisciplinary rehabilitation when peripheral and possible central motor pathway findings coexist following polytrauma.

Perioperative blood loss in spine surgery: quantification of visible and hidden blood loss and associated factors in a Nigerian teaching hospital

Oluwamuyiwa A. Dada, Mercy O. Adetoye, Jide M. Afolayan — Thu, 22 Oct 2026 00:00:00 +0530

Background: Blood loss is an important consideration during spine surgery and may be underestimated when assessment relies on visual estimation alone. Hidden blood loss may also contribute substantially to the overall perioperative blood loss. The objective is to determine the volume and pattern of perioperative blood loss and identify factors associated with increased blood loss among patients undergoing spine surgery at a Nigerian teaching hospital.

Methods: This retrospective observational study included 72 consecutive patients who underwent spine surgery at Ekiti State University Teaching Hospital between July 2022 and June 2026. Demographic, clinical, operative and perioperative hematological information was retrospectively extracted from medical, anesthetic, operative, laboratory, nursing and blood-bank records. Measured intraoperative blood loss, visible blood loss, calculated total blood loss and hidden blood loss were determined. Factors associated with increased blood loss were assessed statistically.

Results: Blood loss was greater in emergency surgery, with increasing numbers of operative levels, and with more extensive procedure categories.

Conclusions: Greater operative extent and more complex procedure categories were associated with higher blood loss in the comparative analyses.

Variation of neutrophil-lymphocyte ratio across global initiative for chronic obstructive lung disease stages in chronic obstructive pulmonary disease

Fateha Naznin, Raihan Kamal Galib, Inzamam Ul Haq — Thu, 22 Oct 2026 00:00:00 +0530

Background: Chronic obstructive pulmonary disease (COPD) is a major cause of morbidity and mortality worldwide, particularly in low- and middle-income countries. As COPD is increasingly recognized as a systemic inflammatory disease, the neutrophil-lymphocyte ratio (NLR) has emerged as a simple and inexpensive inflammatory marker. This study was conducted to assess NLR variation across global initiative for chronic obstructive lung disease (GOLD) stages and evaluate its clinical relevance in relation to COPD severity.

Methods: This hospital-based cross-sectional analytical study included 169 spirometry-confirmed COPD patients aged ≥40 years attending Combined Military Hospital, Dhaka. Sociodemographic, clinical, hematological, biochemical, and pulmonary function data were collected. NLR was calculated from absolute neutrophil and lymphocyte counts, and disease severity was classified according to GOLD staging. Data were analyzed using SPSS version 26, with p<0.05 considered significant.

Results: The mean age was 66.0±8.4 years; 82.0% were male and 74.6% had a smoking history. Most patients were classified as GOLD I (60.9%), followed by GOLD II (26.6%), GOLD III (7.1%), and GOLD IV (5.3%). Mean NLR was 2.7±0.6 and increased progressively from 2.1±0.4 in GOLD I to 4.1±0.8 in GOLD IV. FEV₁% predicted and SpO² declined with increasing severity, while CRP increased. NLR correlated negatively with FEV₁% predicted and FEV₁/FVC ratio and positively with exacerbation frequency, CRP, smoking exposure and disease duration. Higher NLR remained independently associated with smoking burden, exacerbation history, CRP and advanced GOLD stages.

Conclusion: NLR increased significantly with COPD severity and may serve as a simple, inexpensive biomarker for severity assessment and risk stratification.

Real-world evidence study evaluating the effectiveness, tolerability and utilization patterns of vonoprazan in routine clinical practice across an outpatient clinical setting in India

Arka Banerjee, Tanvi Shetty, Kushal Sarda, Akhilesh Sharma — Sat, 05 Sep 2026 00:00:00 +0530

Background: Gastroesophageal reflux disease (GERD) and peptic ulcer disease (PUD) are two of the most common acid-related gastrointestinal conditions in India. They are associated with significant morbidity and impaired quality of life. Vonoprazan has demonstrated clinical efficacy in clinical trials and offers rapid and sustained acid suppression. However, there is still a dearth of empirical data on its therapeutic application and efficacy in Indian patients.

Methods: This multicentre, retrospective, observational real-world evidence study examined medical records from 8,325 patients prescribed Vonoprazan in outpatient settings across India during a 6-month period. Demographic details, indications, dose patterns, symptom improvement, treatment satisfaction, and safety outcomes were assessed using descriptive and comparative statistical methods.

Results: GERD (55.98%) and acid peptic disorders (APD; 33.07%) as diagnosed by the treating physicians were the most common indicators for Vonoprazan treatment. The majority of patients (93.14%) received 20 mg of Vonoprazan once daily. Symptoms improved significantly, with heartburn relief reported in 97.53% of patients and acid regurgitation improvement in 91.80%. Severe heartburn dropped from 44.06% at baseline to 1.93% after treatment (p<0.05), while acid regurgitation decreased from 31.95% to 6.56% (p<0.05). Overall treatment satisfaction was high, with 73.44% of patients reporting being extremely satisfied.

Conclusions: Vonoprazan demonstrated clinically meaningful real-world effectiveness, improvement in symptom control, favourable tolerability, and high patient satisfaction in Indian patients with GERD and other acid-related disorders, supporting its role as an effective therapeutic option in routine clinical practice.

Clinico-epidemiological evaLuation of mAcrolide use In Respiratory tract infections (CLAIR): a retrospective study

Prabhat Kumar Agrawal, Aishwarya Ashokkumar — Sat, 19 Sep 2026 00:00:00 +0530

Background: Respiratory tract infections (RTIs) are frequently seen in clinical practice, and macrolides are widely used for their management in India. However, real-world evidence (RWE) on prescribing patterns and clinical outcomes with macrolide use in RTIs is still limited. This study evaluated utilization patterns and effectiveness of macrolides for RTIs using an electronic medical records (EMR) database.

Methods: This retrospective, observational, EMR-based study analysed anonymized HealthPlix EMR data from January 2017 to June 2025. Adult patients (≥18 years) prescribed erythromycin, roxithromycin, azithromycin, or clarithromycin with a documented follow-up within 20 days were included. Propensity score matching (PSM) was applied for comparative effectiveness analysis between azithromycin and clarithromycin.

Results: A total of 78,499 eligible RTI patients were analyzed. Azithromycin (N=64,638) and clarithromycin (N=12,448) were the most frequently prescribed macrolides. Most patients were aged <60 years. Across macrolides, fever, cold, and cough predominated in upper RTIs (URTIs) whereas cough and dyspnea in lower RTIs (LRTIs), with bronchitis being the most common LRTI diagnosis. Hypertension and diabetes mellitus were the most common comorbidities. A 5–7-day regimen predominated across macrolides. Following PSM (12,448 patients per cohort of azithromycin and clarithromycin), overall symptom resolution was significantly higher with clarithromycin than azithromycin (72.36% vs 64.33%; p<0.001), with similar findings in URTI (74.98% vs 61.15%) and LRTI (69.86% vs 67.36%) subgroups. Symptom resolution remained high after switching to clarithromycin from other antibiotics.

Conclusions: This study provides RWE on macrolide prescribing patterns in RTIs and demonstrates higher symptom resolution with clarithromycin than azithromycin in routine clinical practice.

Clinical effectiveness of co-amoxiclav in upper respiratory tract infections: results from a large multicenter real-world evidence study

Mon, 19 Oct 2026 00:00:00 +0530

Background: Upper respiratory tract infections (URTIs) are among the most common reasons for outpatient consultations and antibiotic prescribing. Although many URTIs are viral, bacterial infections and secondary bacterial complications often require antimicrobial treatment. Co-amoxiclav is widely used for bacterial respiratory infections; however, large-scale real-world evidence (RWE) remains limited. This study evaluated the effectiveness and prescribing patterns of co-amoxiclav in routine clinical practice.

Methods: This multicenter, retrospective, medical record-based RWE study included patients with URTIs who received co-amoxiclav across participating centers. Demographic characteristics, prescribing patterns, and treatment outcomes were evaluated in pediatric (≤12 years) and adult (>12 years) populations. Clinical outcomes were categorized as cure, improvement, or no improvement.

Results: A total of 12,986 patients were included, comprising 1,116 pediatric and 11,870 adult patients. Unspecified URTI was the predominant diagnosis (81.6%), followed by tonsillitis, acute otitis media (AOM), pharyngitis, sinusitis, and laryngitis. Suspension formulations were prescribed more frequently in pediatric patients, whereas tablet formulations predominated among adults. Twice-daily dosing was the most commonly prescribed regimen across age groups. Overall clinical success (cure plus improvement) was achieved in 12,970 patients (99.88%). Complete clinical cure was documented in 12,295 patients (94.7%), while 675 patients (5.2%) showed clinical improvement and only 16 patients (0.1%) reported no improvement. Clinical cure rates were comparable between pediatric and adult populations (93.8% vs. 94.8%, respectively).

Conclusions: Co-amoxiclav demonstrated high rates of clinical cure and overall treatment success in patients with URTIs across pediatric and adult populations, supporting its effectiveness in routine clinical practice when appropriately prescribed for suspected bacterial respiratory infections.

Comparison of inhaler technique errors among asthma patients using two different dry powder inhaler devices before and after pharmacist demonstration

Thu, 22 Oct 2026 00:00:00 +0530

Background: Asthma is a chronic inflammatory airway disease requiring long-term management, with inhalation therapy as the cornerstone of treatment. Incorrect inhaler technique is common and contributes to poor disease control and reduced therapeutic efficacy. Patient education plays an important role in improving inhaler use and treatment outcomes. This study evaluated and compared inhaler technique, error patterns, and improvement following pharmacist demonstration among asthma patients using Revolizer and Lupihaler dry powder inhalers.

Methods: A prospective comparative observational study was conducted in a tertiary care hospital among 302 asthma patients, with 151 patients each using Revolizer and Lupihaler devices. Inhaler technique was assessed at three visits and categorized as good, needing improvement, or poor. Errors in key inhalation steps were documented, and structured pharmacist-led education was provided during follow-up. Data were analyzed using descriptive statistics.

Results: At baseline, good inhaler technique was observed in 31 (20.52%) Revolizer users and 26 (17.21%) Lupihaler users, increasing to 131 (86.75%) and 120 (79.47%) by visit 3. Poor technique declined from 67 (44.37%) to 2 (1.32%) in the Revolizer group and from 54 (36.76%) to 5 (3.31%) in the Lupihaler group. Errors in exhaling fully, inhalation, breath holding, and checking remaining powder decreased in both groups following education, with greater reductions observed among Revolizer users.

Conclusions: Structured pharmacist-led education significantly improved inhaler technique and reduced errors with both dry powder inhalers, with slightly greater improvement observed among Revolizer users. Regular assessment and repeated inhaler education should be incorporated into routine asthma care to optimize treatment outcomes.

Urinary microalbumin as a surrogate marker of sequential organ failure assessment – defined organ dysfunction in sepsis

Manoj Kumar Mathur, Savinay Mehrotra, Poonam Gupta, Ajeet Kumar Chaurasia — Thu, 22 Oct 2026 00:00:00 +0530

Background: Sepsis causes dysregulated host responses to infection, endothelial injury, increased vascular permeability, and organ dysfunction. Urinary microalbumin reflects endothelial dysfunction and capillary leak, but its relationship with organ dysfunction severity requires further evaluation.

Methods: This hospital-based observational cross-sectional study was conducted in a tertiary care teaching hospital between 2025-2026. One hundred adults with sepsis were enrolled. Urinary microalbumin was measured at presentation and SOFA scores were calculated. Clinical, laboratory, and outcome-related variables were compared across sequential organ failure assessment (SOFA) severity categories. Pearson correlation was used to assess the relationship between urinary microalbumin and SOFA score.

Results: Out of 100 patients, 35% had mild, 51% moderate, and 14% severe organ dysfunction. Mean urinary microalbumin increased from 49.62±28.45 mg/l in mild dysfunction to 77.60±49.05 mg/l in moderate and 116.64±74.16 mg/l in severe dysfunction (F=10.17, p<0.001). Urinary microalbumin correlated positively with SOFA score (r=0.368, p<0.001). Increasing SOFA severity was associated with lower MAP and GCS, higher blood urea nitrogen, creatinine levels, greater vasopressor and mechanical ventilation requirements.

Conclusion: Urinary microalbumin was significantly associated with SOFA-defined organ dysfunction severity in sepsis. It may serve as a simple, non-invasive adjunct biomarker for early severity assessment and risk stratification.

A comparative study on substance abuse problems among adolescent girls and boys in urban and rural field practice areas of South India

Mercy P., P. Leela Prasad — Thu, 22 Oct 2026 00:00:00 +0530

Introduction: Adolescence is a vital period of human growth and development. Substance abuse is a major public health issue because it affects younger people more and more and causes serious health, social, and financial issues. This study was conducted to assess and compare substance abuse among school-going adolescent girls and boys in urban and rural areas of South India.

Method: A school-based cross-sectional study was conducted among 416 adolescent girls and boys aged 10–19 years residing in the urban and rural field practice areas of Kurnool Medical College. Data were collected between March 2023 and March 2025 using a semi-structured questionnaire through a simple random sampling technique. Permission from the institutional ethics committee (IEC) was obtained, and written informed consent was secured from the participants. Data were analyzed using SPSS Version 21.

Results: The prevalence of substance abuse was higher in urban areas (4.32%) than in rural areas (2.88%). The most common type of substance abuse was smoking tobacco in both urban (1.92%) and rural areas (1.44%). Most participants consumed alcohol occasionally in both urban (0.96%) and rural areas (0.96%). Smoking tobacco was the most commonly used form of tobacco in both urban and rural areas.

Conclusion: The prevalence of substance abuse was higher in urban areas compared to rural areas. Friends were the most common first alcohol-drinking partners in both urban and rural areas. Awareness programs should be initiated, along with educating parents, teachers, and peer groups about the harmful effects of tobacco and substance use.

Study on clinical and haematological profile of pancytopenia with special reference to bone marrow picture

Pradeep G. S., Rohith C. — Thu, 22 Oct 2026 00:00:00 +0530

Background: Pancytopenia is a hematological condition characterized by the simultaneous reduction of red blood cells, white blood cells, and platelets. It represents a manifestation of various underlying disorders, ranging from nutritional deficiencies to hematological malignancies. Understanding the clinical and hematological profile, especially bone marrow morphology, is critical for diagnosis and management.

Methods: An observational study was conducted over 18 months at the Department of Medicine, K R Hospital, Mysuru, enrolling 35 adult patients diagnosed with pancytopenia. Detailed clinical history, physical examination, complete blood count, peripheral smear, serum vitamin B12 and folate levels, and bone marrow aspiration and biopsy were performed. Additional investigations were conducted as clinically indicated. Data were analyzed using appropriate statistical methods.

Results: The study population comprised 54.3% males and 45.7% females, with the majority aged between 31-40 years. The most common presenting symptom was easy fatigability (94.3%). Pallor was observed in all patients, with splenomegaly present in 51.4%. Hematological analysis revealed severe anemia, leukopenia, and thrombocytopenia. Peripheral smear predominantly showed macrocytic anemia (54.3%). Bone marrow examination revealed hypercellularity in 74.3% of cases. Megaloblastic anemia was the leading cause of pancytopenia (48.6%), followed by hypersplenism (14.3%) and aplastic anemia (11.4%).

Conclusions: Megaloblastic anemia due to vitamin B12 deficiency is the predominant cause of pancytopenia in this cohort, emphasizing the need for early nutritional assessment and intervention. Bone marrow evaluation remains a pivotal diagnostic tool, aiding in the identification of diverse etiologies and guiding appropriate management.

Evaluation of cardiovascular risk using the Framingham risk score among adults attending a tertiary care centre: a cross-sectional study

Mohammed Rafeequ K., Rakesh M., Salma Anwar, Thameem E. N. — Thu, 22 Oct 2026 00:00:00 +0530

Background: Cardiovascular disease (CVD) remains the leading cause of morbidity and mortality in India. The Framingham risk score (FRS) is a validated tool for estimating 10-year CVD risk; however, data on its applicability in tertiary care settings in Kerala are scarce.

Objective: To evaluate the 10-year cardiovascular risk profile of adults attending a tertiary care centre using the FRS and to identify factors associated with high cardiovascular risk.

Methods: A cross-sectional study was conducted among 450 adults aged 30–75 years attending outpatient departments of a tertiary care centre in Thiruvananthapuram, Kerala, from January to June 2026. The FRS was calculated using standard variables: age, sex, total cholesterol, HDL cholesterol, systolic blood pressure, antihypertensive treatment status, and smoking status. Participants were categorised as low (<10%), intermediate (10-19%), or high (≥20%) risk.

Results: The mean age of participants was 52.4±11.8 years (218 males, 232 females). The overall mean FRS was 17.4±9.2%. A total of 154 participants (34.2%) were categorised as high risk (FRS≥20%), 184 (40.9%) as intermediate risk, and 112 (24.9%) as low risk. Males had a significantly higher mean FRS than females (19.8% vs. 15.3%, p=0.003). Hypertension (OR 2.87; 95% CI 2.14-4.55), diabetes mellitus (OR=2.31), and current smoking (OR=1.94) were the strongest independent predictors of high cardiovascular risk.

Conclusions: A substantial proportion of adults attending this tertiary care centre are at high cardiovascular risk. The FRS is an effective and feasible screening tool in this setting. Targeted interventions addressing hypertension, diabetes, and tobacco use are urgently needed to reduce the CVD burden in this population.

A clinico-epidemiological profile of Hansen’s disease in a tertiary care center – insights from the post-elimination era

Thu, 22 Oct 2026 00:00:00 +0530

Background: Although leprosy was officially eliminated as a public health problem in India in 2005, several districts and blocks continue to report new cases, indicating ongoing transmission. This study aimed to assess the current clinical and epidemiological profile of leprosy patients attending a tertiary care hospital.

Methods: A prospective observational study was conducted among patients diagnosed with Hansen’s disease at a tertiary care hospital, between August 2020 to August 2025. Diagnosis was based on WHO criteria and classified according to the Ridley-Jopling system. Data on demographic characteristics, clinical presentation, treatment, complications, deformities, and yearly trends were analysed.

Results: A total of 117 patients were registered during the study period, with a male-to-female ratio of approximately 2:1. Children (≤14 years) constituted less than 2% of cases. Multibacillary (MB) leprosy was the predominant clinical type (58.94%). Borderline-borderline leprosy was the most common morphological subtype (43.58%), followed by borderline tuberculoid (BT) (25.33%), tuberculoid (TT) (10.25%), lepromatous (LL) (5.98%), borderline lepromatous (BL) (3.41%), pure neurotic (1.70%), and histoid and indeterminate leprosy (0.85% each). Lepra reactions were observed in 11.11% of patients. World health organization (WHO) Grade II deformity was present in 0.66%, with claw hand being the most common deformity.

Conclusions: The study highlights the persistence of leprosy transmission despite low overall prevalence. The predominance of MB and borderline forms suggests ongoing community transmission. Strengthening early case detection, health education, treatment adherence, and disability prevention measures remain essential for effective disease control.

Effects of multistrain probiotic supplementation on systemic inflammation, nutritional status, functional capacity and quality of life in maintenance hemodialysis: an open-label randomized controlled trial

Maulik Patel, Gaurang Patel, Girish Chaudhary, Akash Dholakia — Thu, 22 Oct 2026 00:00:00 +0530

Background: Persistent inflammation, protein-energy wasting, impaired physical function and reduced health-related quality of life are common among patients receiving maintenance hemodialysis. Intestinal dysbiosis and increased exposure to gut-derived inflammatory mediators may contribute to these abnormalities. This study evaluated the effects of multistrain probiotic supplementation on inflammatory, nutritional, functional, clinical, safety and patient-reported outcomes in adults undergoing maintenance hemodialysis.

Methods: This prospective, single-center, open-label, parallel-group randomized controlled trial enrolled 60 adults receiving maintenance hemodialysis. Participants were randomized in a 1:1 ratio to receive a daily four-strain probiotic plus standard hemodialysis care or standard care alone for 6 months. The primary outcome was the systemic immune-inflammation index (SII) at month 6. Secondary outcomes included the neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), red cell distribution width (RDW), serum albumin, malnutrition-inflammation score (MIS), handgrip strength, kidney disease quality of life-36 (KDQOL-36), hospitalization, adherence, nutritional response, all-cause mortality and adverse events.

Results: At month 6, the probiotic group had significantly lower SII (p=0.013), NLR (p=0.024), CRP (p=0.045), RDW (P=0.010) and MIS (p=0.018) and significantly higher serum albumin (p=0.005), handgrip strength (p=0.027) and KDQOL-36 scores (p=0.031) than the control group. No statistically significant between-group differences were observed in hospitalization, adherence, predefined nutritional response, all-cause mortality, gastrointestinal adverse events or serious intervention-related adverse events.

Conclusions: Six months of multistrain probiotic supplementation was associated with favorable changes in systemic inflammation, nutritional status, muscle strength and kidney disease-specific quality of life among adults receiving maintenance hemodialysis. No detectable benefit was observed for hospitalization, mortality or adverse-event frequency. These findings should be interpreted cautiously because of the modest sample size and open-label, single-center design.

A study on risk factors, clinical profile and outcome of patients with acute kidney injury in the intensive care unit of a tertiary care hospital

Ram Prasad, Kothai Gnanamoorthy, Hariprasad — Thu, 22 Oct 2026 00:00:00 +0530

Background: Acute kidney injury (AKI), is a prevalent and serious condition in the intensive care unit (ICU) that significantly increases the risk of morbidity and mortality. This study aims to evaluate the risk factors, clinical profile, and outcomes of patients with AKI admitted to the intensive care unit.

Methods: This longitudinal study was conducted in patients with AKI admitted to the ICU of the ESI Medical College, Chennai. After obtaining approval from the Institutional Ethics Committee, data from patients with AKI, demographic profiles, laboratory parameters and outcomes were collected and analysed using appropriate statistical methods.

Results: Sepsis is the main cause of acute renal damage (69%) and is common in critically ill patients aged > 50 years. The results showed that the development of AKI is complicated and multifaceted, with important contributions from hypotension (27%), fever (17%), oliguria (16%), and concomitant diseases such as diabetes (43%) and hypertension (20%). Patients in the RIFLE criteria's "Failure" group (71%) had the most severe renal impairment and higher rates of both progression to CKD and death.

Conclusions: Sepsis was the most prevalent risk factor in the study. The outcomes of AKI did not show a significant correlation with age and sex, suggesting that other factors are more influential in determining the prognosis. Overall, these results emphasise the multifaceted nature of AKI and the importance of a holistic approach for its management.

Correlation of red cell distribution width with the severity of coronary artery disease on coronary angiography as assessed by modified Gensini score in acute coronary syndrome patients

Rajat Pachori, Vishnu Sharma, Vansh Bagrodia — Thu, 22 Oct 2026 00:00:00 +0530

Background: Coronary artery disease (CAD) remains a leading cause of global mortality, with Indian populations experiencing earlier onset and higher death rates. While traditional biomarkers aid diagnosis, their limitations in early detection necessitate alternative indicators. Red cell distribution width (RDW), an inexpensive and routinely measured hematological parameter, has emerged as a potential marker for cardiovascular risk stratification. Objectives were to evaluate the association of RDW with the severity of CAD assessed via the modified Gensini score (MGS) in patients presenting with acute coronary syndrome (ACS).

Methods: This cross-sectional observational study enrolled 500 consecutive patients presenting with ACS at a tertiary care center in Jaipur, India, between November 2018 and April 2020. All participants underwent diagnostic coronary angiography (CAG). CAD severity was quantified using the MGS mild: ≤80 and severe: >80. Complete blood count parameters, including RDW-CV and RDW-SD, were measured and analyzed across subgroups defined by disease severity, number of diseased vessels, myocardial infarction subtype, and in-hospital outcomes.

Results: Elevated RDW-CV (>13.7%) was significantly associated with severe CAD (p=0.009). Patients with higher RDW-CV had significantly higher Gensini scores (mean: 13.76±0.53% vs. 13.65±0.39%, p=0.048). However, no statistically significant associations were observed between RDW-CV or RDW-SD and the number of diseased vessels (p>0.05), infarction subtypes (p>0.05), or in-hospital mortality (p>0.05). Receiver operating characteristic (ROC) analysis demonstrated that an RDW-CV cutoff of >13.7% predicted severe CAD with an area under the curve (AUC) of 0.651 (95% CI: 0.549-0.744; sensitivity: 68.7%, specificity: 64.7%).

Conclusions: Elevated RDW-CV correlates significantly with angiographic severity of CAD in patients presenting with ACS. However, its capacity to discriminate multi-vessel involvement or acute in-hospital mortality remains limited.

Artificial intelligence in healthcare and human resource management: a review of the global divide, Pakistan's landscape and institutional innovations

Thu, 22 Oct 2026 00:00:00 +0530

Artificial intelligence (AI) is reshaping healthcare and organizational management worldwide, yet its benefits remain unevenly distributed between high-income and low- and middle-income countries (LMICs). This review examines the structural drivers of this global AI divide, situates Pakistan's healthcare and digital infrastructure challenges within this context, and presents an institutional case study of four AI-enabled interventions implemented at the Sindh Integrated Emergency and Health Services (SIEHS), an emergency and health services organization under the Health Department, Government of Sindh, Pakistan: an AI-driven recruitment and candidate-job matching system (Talent Match Live), a facial-recognition and geolocation-based field monitoring application, an AI-assisted CCTV training-monitoring system, and an AI-augmented telemedicine triage service embedded within SIEHS's Teletabeeb telehealth department. Each intervention is evaluated against comparable systems documented in the international literature to assess feasibility, evidence of effectiveness, and associated ethical risks. A responsible-adoption framework is proposed to guide organizations in resource-constrained settings toward AI integration that is effective, equitable, and ethically governed. The review concludes that while AI offers meaningful efficiency and access gains for LMIC public-sector organizations such as SIEHS, sustainable adoption requires deliberate attention to data protection, algorithmic bias, workforce consent, and alignment with international ethical guidance.

Science of well-being and homoeopathy

Thu, 22 Oct 2026 00:00:00 +0530

The article discusses about the science of wellbeing, its modalities and its impact on epidemiology, interventions that include health promotion, prevention and treatment (PPT) approaches. The concept of wellbeing in the article is seen through the concept of psychology and medicine where the emotional, mental and physical health aspects are taken into account. It also discusses the supportive therapies around the PPT triad. The public health dimension of the well- being concept is also dealt in this article. The article discusses the role that homoeopathic therapeutics can play in the domain of new treatment options to deal with the acute, sub-acute and chronic cases. Homoeopathy can be a supportive therapy that can help to deal with the upcoming challenges not only in the morbidity profile but also the mortality profile. Homoeopathy has repeatedly proved its efficacy in chronic diseases of all natures since the last two and half centuries.

Real-world clinical and molecular profile of ovarian cancer patients treated with Olaparib: study protocol and design of the OC-REAL India multicentre ambispective observational study

Thu, 22 Oct 2026 00:00:00 +0530

Background: Globally, ovarian cancer (OC) is the eighth most common cancer among women, accounting for an estimated 3.7% of all cases and 4.7% of cancer-related deaths. Approximately 20-25% of OC cases harbour germline BRCA1/2 mutations, while homologous recombination deficiency (HRD) has emerged as an important therapeutic biomarker. Poly (ADP-ribose) polymerase (PARP) inhibitors, such as Olaparib, have demonstrated significant clinical benefit as maintenance therapy in patients with BRCA-mutated or HRD-positive OC. However, real-world Indian data on the clinical and molecular characteristics of patients receiving Olaparib remain limited. The objective of the study was to evaluate the clinical, molecular, and treatment profile of OC patients receiving Olaparib maintenance therapy.

Methods: This ambispective, cross-sectional, multicentre, non-interventional, real-world evidence study aims to enrol 250 Indian OC patients initiated on Olaparib maintenance therapy. Data will be captured electronically at a baseline visit using an electronic data capture (EDC) system. Variables include demographics, comorbidities, family cancer history, histopathology, surgical and treatment history, BRCA mutation and HRD status, CA-125 levels at diagnosis and prior to Olaparib initiation, and details of maintenance therapy.

Conclusions: OC-REAL India study will provide real-world insights into Indian OC patients on Olaparib, including demographics, pathology, and BRCA/HRD mutation prevalence. Findings aim to support personalized treatment and improve clinical outcomes. As this is an ongoing study, the results are expected to be published after completion of the study.

Trial registration: The study was registered with the Clinical Trials Registry-India (CTRI; Registration No. CTRI/2025/08/092561)

Beyond probiotics: targeting the microbiota-metabolite axis in radiation-induced diarrhea

Halil Sağınç — Thu, 22 Oct 2026 00:00:00 +0530

Radiation-induced diarrhea remains a common complication of pelvic radiotherapy, with limited preventive strategies available. Although probiotics have been investigated as a potential supportive intervention, current evidence is heterogeneous and insufficient to support their routine use. Emerging data suggest that radiation-induced gut microbiota alterations and disruption of microbiota-derived metabolites, including short-chain fatty acids, may play a critical role in intestinal injury. Targeting the microbiota–metabolite axis may represent a promising future approach for personalized prevention and management of radiation-induced gastrointestinal toxicity.

Stem cell transplantation from a space person in a haematological cancer patient

Debajani Deka, Sanjay Mishra — Thu, 22 Oct 2026 00:00:00 +0530

Epigenetic changes are a reversible process. The epigenetic changes are: methylation, histone modification, and non-coding RNA. Through processes such as DNA methylation, histone modification and non-coding RNA action, the chromatin state is altered, thereby influencing gene activation. Moreover, epigenetic modifications can respond to environmental exposures. DNA methylation typically silences genes by adding methyl groups to cytosine bases neighbouring guanines; chemical modifications in histone tails can either loosen or tighten DNA winding around histones, affecting accessibility to transcription factors; and non-coding RNAs can interfere with transcription or translation processes.