Research Article
Open Access
Prevalence of Cutaneous Manifestations in Patients with Diabetes Mellitus: A Prospective Study
Deepali
Katke,
Sanjay
Katke,
Tanvi
Katke
Pages 164 - 169

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Abstract
Background Cutaneous manifestations are common in patients with diabetes mellitus (DM) and may serve as early indicators of glycemic disturbances or complications. Despite their high frequency, there is limited data on the spectrum and prevalence of skin disorders in diabetic patients in the Indian clinical setting. This study aimed to investigate the prevalence and pattern of cutaneous manifestations in patients with diabetes mellitus attending DY Patil University, School of Medicine, Ambi, Pune. Methods: A prospective observational study was conducted over a 6-month period (June 2025 – December 2025) at the Department of Medicine and Dermatology, DY Patil University, School of Medicine, Ambi, Pune. A total of 100 patients with a confirmed diagnosis of diabetes mellitus (both type 1 and type 2) were enrolled consecutively. Detailed dermatological examinations were performed for each patient to identify cutaneous signs. Relevant clinical history, duration of diabetes, glycemic control (HbA1c), and associated comorbidities were recorded. Descriptive statistics were used to determine the prevalence of cutaneous manifestations. Results: Among the 100 diabetic patients studied, cutaneous manifestations were identified in a majority of cases. The overall prevalence of skin changes was X% (n = Y). The most common dermatological findings included:
- Infections (fungal and bacterial) – observed in A%
- Diabetic dermopathy – seen in B%
- Xerosis and pruritus – recorded in C%
- Acanthosis nigricans – present in D%
- Bullous disorders and neuropathic ulcerations – less frequent but clinically significant
A statistically significant association was observed between poor glycemic control (HbA1c >7%) and the presence of certain skin manifestations (p < 0.05). The duration of diabetes also correlated with increased frequency of dermatological abnormalities. Conclusion: Cutaneous manifestations are highly prevalent in patients with diabetes mellitus and encompass a wide spectrum of infectious and non-infectious conditions. Early recognition of skin changes can aid in timely diagnosis, optimization of glycemic control, and prevention of complications. Routine dermatological assessment should be integrated into the clinical care of diabetic patients to improve overall outcomes.
Research Article
Open Access
A Mixed Method study on the Evaluation of Fall Risk, Functional Status, and Fall-Related outcomes among the Elderly population in Rural South India
Pages 152 - 163

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Abstract
Background: Falls among the elderly have become a major public health concern globally, with the rapid increase in ageing population. Objectives of the study were to assess the fall risk status of the elderly people, their activities of daily living and functional dependence, and to understand the impact of falls on both the elderly and their caregivers. Methodology: This community based mixed method study was conducted in rural South India among 350 elderly people aged more than 65 years using a pre-tested structured questionnaire from March 2025 to June 2025. Dependence on daily activities, fall risk assessment and risk factors for elderly fall were assessed by quantitative method. Qualitative method was used to better explore the effects of fall among the elderly. Mean, median, proportions and chi-square test were used to analyse quantitative data. The data collected by in-depth interview were analysed by thematic content analysis. Results: Prevalence of fall was found to be 58.8%. 97.1% were fully independent for their daily activities and 76% had low risk of fall based on Fall Risk Assessment tool. Dependence on family members, social withdrawal were some of the problems faced by the elderly after fall. Helping the elderly in doing their routine activities and restriction of activities were some of the challenges faced by the caregivers of elderly. Conclusion: Elderly individuals are at risk of falls due to advancing age and associated health conditions like vision impairment and mobility issues. Caregivers also face considerable challenges, including increased responsibilities and limited support.
Research Article
Open Access
Prevalence and Clinical Correlation of Metabolic Syndrome Among patient with Type 2 Diabetes Mellitus Above 30 Years of Age
Shailja
Khansili,
Sudiksha
Rana
Pages 149 - 151

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Abstract
Background: There is a common pathophysiological basis rooted in insulin resistance for both Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). Their coexistence significantly amplifies cardiovascular morbidity and mortality. Objective: To evaluate the prevalence of metabolic syndrome (MetS) among patients with Type 2 Diabetes mellitus (T2DM) aged ≥ 30 years and assess the clinical and biochemical correlations between diabetes parameters and components of metabolic syndrome. Methods: A cross-sectional study was conducted over one year in fifty admitted patients aged ≥ 30 years with established T2DM in the Department of General Medicine at Shri Guru Ram Rai Institute of Medical and Health Sciences, Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India. Metabolic syndrome was diagnosed using NCEP ATP III criteria. Anthropometric, clinical, and biochemical variables were recorded and analyzed using appropriate statistical tests. Results: Among 50 admitted participants (mean age 53.6 ± 9.1 years), 28 patients (56%) fulfilled criteria for metabolic syndrome. Most prevalent components were Central obesity (72%), hypertension (68%), and low HDL cholesterol (60%). Mean BMI was significantly higher in the metabolic syndrome group (30.4 ±2.6 kg/m²) compared to non-metabolic syndrome group (27.9 ± 2.3 kg/m2; p<0.001). In MetS patients, mean HbA1c levels were also higher (8.6 ± 1.1%) in comparison to non-MetS (7.8 ±0.9%; p=0.02). There were significant positive correlations between waist circumference and triglyceride levels (r=0.48, p=0.003). Conclusion: It was observed that more than half of Type 2 DM patients over 30 years demonstrated metabolic syndrome. Major dominant contributors were central obesity and hypertension. Routine MetS screening should be integrated into diabetes management to reduce cardiovascular risk burden.
Research Article
Open Access
Shailja
Khansili,
Sudiksha
Rana
Pages 149 - 151
Background: There is a common pathophysiological basis rooted in insulin resistance for both Type 2 diabetes mellitus (T2DM) and metabolic syndrome (MetS). Their coexistence significantly amplifies cardiovascular morbidity and mortality. Objective: To evaluate the prevalence of metabolic syndrome (MetS) among patients with Type 2 Diabetes mellitus (T2DM) aged ≥ 30 years and assess the clinical and biochemical correlations between diabetes parameters and components of metabolic syndrome. Methods: A cross-sectional study was conducted over one year in fifty admitted patients aged ≥ 30 years with established T2DM in the Department of General Medicine at Shri Guru Ram Rai Institute of Medical and Health Sciences, Shri Mahant Indiresh Hospital, Dehradun, Uttarakhand, India. Metabolic syndrome was diagnosed using NCEP ATP III criteria. Anthropometric, clinical, and biochemical variables were recorded and analyzed using appropriate statistical tests. Results: Among 50 admitted participants (mean age 53.6 ± 9.1 years), 28 patients (56%) fulfilled criteria for metabolic syndrome. Most prevalent components were Central obesity (72%), hypertension (68%), and low HDL cholesterol (60%). Mean BMI was significantly higher in the metabolic syndrome group (30.4 ±2.6 kg/m²) compared to non-metabolic syndrome group (27.9 ± 2.3 kg/m2; p<0.001). In MetS patients, mean HbA1c levels were also higher (8.6 ± 1.1%) in comparison to non-MetS (7.8 ±0.9%; p=0.02). There were significant positive correlations between waist circumference and triglyceride levels (r=0.48, p=0.003). Conclusion: It was observed that more than half of Type 2 DM patients over 30 years demonstrated metabolic syndrome. Major dominant contributors were central obesity and hypertension. Routine MetS screening should be integrated into diabetes management to reduce cardiovascular risk burden.
Research Article
Open Access
Lung Ultrasound in the Evaluation of Pulmonary Tuberculosis in Adults
Shweta
Koli,
Sumit
Kumar,
Vinita
Rathi
Pages 137 - 148

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Abstract
We evaluated lung ultrasound (LUS) use in diagnosing pulmonary TB (PTB) in adults. From Sept 2022 to Feb 2024, 100 patients (12–60 years) with suspected or confirmed PTB were enrolled in a prospective study. A trained radiology resident performed LUS, including upper abdominal scanning (“extended LUS”). LUS was considered positive if two of three findings—subpleural nodules, consolidation, or “isolated” converging B-lines—were present. Sensitivity and specificity were calculated using microbiological confirmation or clinical-radiological response to therapy as reference.
Six patients were PTB-negative. LUS showed findings in 98% (71% females). Common findings: converging B-lines (77%), consolidation (65%), regular B-lines (64%), subpleural nodules (50%), miliary pattern (43%), confluent B-lines (23%), pleural effusion (15%), pleural irregularity (12%), and cavities (7%). Sensitivity and specificity of LUS were 62.8% and 83.3%, respectively. Extended LUS improved sensitivity to 69.1%.
In conclusion LUS, especially extended LUS, is a useful adjunct in PTB diagnosis.
Research Article
Open Access
Lateral Dorsal Infundibular Approach for Difficult Laparoscopic Cholecystectomy
Manmohan
Singh,
Mir
Saiqa
Shafi,
Mir
Mujtaba
Ahmed,
Nadeem
Rashid
Pages 132 - 136

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Abstract
Background Difficult laparoscopic cholecystectomy remains a major contributor to bile duct injury (BDI), particularly when the critical view of safety (CVS) cannot be achieved due to severe inflammation, fibrosis, or distorted anatomy. Bailout strategies that avoid dissection in Calot’s triangle are therefore essential. We describe our experience with a modified lateral dorsal infundibular approach for difficult laparoscopic cholecystectomy, designed to facilitate safe subtotal cholecystectomy (STC) while minimizing operative complexity and risk. Methods A retrospective analysis of prospectively maintained data was performed on patients undergoing difficult laparoscopic cholecystectomy at a tertiary care center between April 2025 and January 2026. Patients with preoperative predictors and/or intraoperative findings of difficult gallbladder who ultimately required STC were included. Demographic data, imaging findings, operative details, postoperative outcomes, and complications were analyzed. The surgical technique emphasized subserosal dorsal infundibular dissection above Rouviere’s sulcus, avoiding Calot’s triangle. Results Seventy-two patients with difficult laparoscopic cholecystectomy were analyzed (mean age 55.1 years; 70.8% female). Acute cholecystitis was present in 41.6%, including gangrenous cholecystitis in 25%. Conversion to open surgery was required in one patient (1.38%). The lateral dorsal infundibular approach was successfully completed laparoscopically in 90.3% of cases. Fenestrating STC was performed in 2.7% and reconstituting STC in 6.9%. Postoperative bile leak occurred in two patients (2.7%) and resolved with ERCP. There were no bile duct or vascular injuries, no reoperations, and no mortality. Mean operative time was 85.5 ± 21.5 minutes, and mean hospital stay was 8.6 ± 3.2 days
Research Article
Open Access
Clinical Profile of Anaemia in Geriatric Patients at Tertiary Care Centre
Neelima
Deshpande,
Deepayan
K
Biswas,
Gajanan
Halkanche,
Deepak
Patil,
Uday
Mohite
Pages 125 - 131

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Abstract
Background: Anaemia is a prevalent condition among geriatric patients, associated with increased morbidity, mortality, and reduced quality of life. This study aimed to evaluate the clinical profile, etiological factors, and complications of anaemia in elderly individuals at a tertiary care centre. Methods: A prospective, hospital-based observational study was conducted over two years, involving 2700 patients aged >60 years with anaemia (haemoglobin <13 g/dL in males, <12 g/dL in females). Data collection included detailed clinical history, physical examination, laboratory investigations (complete blood count, peripheral smear, iron studies, etc.), and radiological assessments. Anaemia severity was graded as mild (10.1–13 g/dL), moderate (7–10 g/dL), or severe (<7 g/dL). Statistical analysis assessed associations between variables. Results: The mean age was 67.81 ± 4.51 years, with 67.96% in the 61–70 years group and a female predominance (59.56%). Generalized weakness (30.04%) was the most common symptom, followed by breathlessness (20.41%). Radiological findings highlighted chronic kidney disease (29.93%) and acute kidney disease (29.11%). Moderate anaemia predominated (74.59%), with normocytic normochromic at 32% and normocytic hypochromic pattern at 32%, followed by microcytic hypochromic pattern at 21%. Nutritional anaemia (30.81%) was the leading cause, followed by chronic kidney disease (29.92%). Peripheral smear findings showed a significant association with anaemia severity (p < 0.0001), but no significant links with age or gender. Conclusion: Anaemia in geriatric patients is multifaceted, primarily driven by nutritional deficiencies and chronic diseases like kidney and liver disorders. Early screening and targeted interventions are crucial to mitigate functional decline and improve outcomes in this vulnerable population.
Research Article
Open Access
AGING AND HEALTH CARE: RASAYANA
Dr. Gyan Prakash
,
Dr. Anurag Pandey
,
Dr. Mamta Tiwari
Pages 116 - 124

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Abstract
Geriatrics is the branch of medicine concerned with the care and treatment of elderly. In human body Dhatus get degenerated as the age advances due to prolonged structural and functional changes. During old age we cannot enhance the capacity of Dhatus, but they can be protected and rejuvenated. According to Ayurveda the drugs used for promoting and preserving health, strength and longevity in a healthy person are called Rasayana. They increase Bala and Ojas in healthy persons or recognized as on Ojaskara (vitalizer) in healthy subjects in general, they also subside the symptom of different diseases. The Rasayana maintain the entirety of Saptadhatu and optimum strength of body and senses promote memory, intelligence, and bodily glow, preserve youth age, lusture, complexion, voice and generosity. These effects of Rasayans can be proved by their antioxidant and adaptogenic properties. Adaptogens show the similar effects like Medhya, Pushtikara, Dhatuvriddhikara, Dehindri yadridhikara, Jivniya and improve immune system of body. Rasayanas act as immuno stimulatants, anabolics and geriatric remedies. The present article takes review on use of Rasayanas in Geriatric health care.
Research Article
Open Access
Artificial Intelligence–Enabled ECG Triage in the Emergency Department: Comparison with Standard Physician-Led Triage for Arrhythmia Recognition
Dr Eshan Chopra
,
Dr Akshi Goel
,
Anurati Raina
Pages 111 - 115

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Abstract
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Abstract
Background: Rapid and accurate recognition of cardiac arrhythmias in the emergency department (ED) is essential to prevent adverse outcomes. Artificial intelligence (AI)–enabled ECG interpretation systems have shown promising diagnostic capabilities, but comparative data with physician-led triage in real-world emergency settings remain limited. Aim: To compare the diagnostic accuracy of AI-enabled ECG triage with standard physician-led triage for arrhythmia recognition in the emergency department. Materials and Methods: This prospective cross-sectional comparative study included 80 adult patients presenting to the ED who underwent 12-lead ECG evaluation. ECGs were independently interpreted by an AI-enabled system and emergency physicians. Cardiologist-confirmed diagnosis served as the gold standard. Diagnostic accuracy, sensitivity, specificity, predictive values, agreement (Cohen’s kappa), and time taken for arrhythmia recognition were analyzed. Statistical significance was set at p < 0.05. Results: AI-enabled triage correctly detected arrhythmias in 88.8% of cases compared to 82.5% by physician-led triage (p = 0.042). Overall diagnostic accuracy was significantly higher for AI (88.8 ± 4.6%) than physicians (82.5 ± 5.3%; p = 0.002). AI demonstrated sensitivity of 91.3% and specificity of 88.2% (p < 0.001). Substantial agreement was observed between AI and physician interpretation (κ = 0.74, p < 0.001). The mean time to arrhythmia recognition was significantly shorter with AI (1.82 ± 0.64 minutes) compared to physician triage (4.73 ± 1.21 minutes; p < 0.001). Conclusion: AI-enabled ECG triage demonstrated superior diagnostic accuracy and significantly reduced interpretation time compared to standard physician-led triage. AI systems may serve as effective decision-support tools in emergency settings, enhancing efficiency and diagnostic reliability while complementing physician expertise.
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Research Article
Open Access
Predictive Ability of Vasoactive–Inotropic Score (VISmax) in Predicting Prolonged ICU Stay After Cardiac Surgery
Dr Akshi Goel
,
Dr Arun Maheshwari
,
Dr Elvin Daniel
,
Dr Eshan Chopra
Pages 107 - 110

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Abstract
Prolonged ICU stay increases morbidity after cardiac surgery. Early identification of patients at risk is crucial.VIS quantifies pharmacological cardiovascular support and may predict adverse outcomes. Objective: To evaluate the predictive ability of maximum vasoactive–inotropic score (VISmax) in predicting prolonged ICU stay (>48 hours) in patients undergoing cardiac surgery. Methods: Prospective observational study of 107 patients. VISmax was calculated during the postoperative period. Patients were categorized into two groups: ICU stay ≤48 hours and >48 hours. Statistical analysis included Mann–Whitney U test, Spearman correlation, and receiver operating characteristic (ROC) curve analysis performed. Results: VISmax significantly associated with prolonged ICU stay (P<0.0001). AUC=0.995. Cut-off >15.5 showed 93.75% sensitivity and 100% specificity. Conclusion: VISmax is an excellent early predictor of prolonged ICU stay following cardiac surgery. A threshold of >15.5 demonstrates near-perfect discrimination and may aid in early risk stratification
Research Article
Open Access
Evaluation of the Effectiveness of Antimicrobial Stewardship Programs in Reducing Antibiotic Resistance
Pages 93 - 98

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Abstract
Environmental contamination in hospital settings is a major contributor to Hospital-Acquired Infections (HAIs), posing significant risks to patients and healthcare workers. Effective monitoring of microbial contamination is essential to guide infection prevention strategies. Methods: A prospective observational study was conducted from January to June 2025. A total of 80 environmental samples, including surface swabs, air, and water samples, were collected from high-touch areas and critical hospital zones. Microbiological testing was performed using culture-based methods, with bacterial and fungal species identified and quantified in Colony-Forming Units (CFU). Data were analyzed to assess contamination patterns, differences across wards, surfaces, and temporal trends. Results: Of the 80 samples, 52 (65%) were positive for microbial growth. Surface swabs showed the highest contamination, followed by water and air samples. Predominant microorganisms included Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., and Candida albicans. ICUs and high-touch surfaces exhibited the highest microbial load. Temporal analysis revealed fluctuations in contamination over the six months. Conclusion: Microbiological testing is an effective tool for monitoring environmental contamination and guiding targeted infection control interventions. Routine surveillance of high-risk areas is recommended to reduce HAIs and enhance patient safety.
Research Article
Open Access
Comparative Evaluation of HbA1c-Derived vs Fasting Indices (HOMA-IR, TyG) for Detecting Insulin Resistance in Hypertensive Patients
Dr Subhash Musale
,
Dr Parth Musale
Pages 87 - 92

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Abstract
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Abstract
Background: Insulin resistance plays a central role in the pathophysiology of hypertension and significantly contributes to cardiovascular morbidity. Early detection of insulin resistance in hypertensive patients is essential for timely intervention. Although HOMA-IR is widely used for insulin resistance assessment, its clinical applicability is limited by the requirement for insulin assays. Alternative surrogate markers such as the triglyceride–glucose (TyG) index and HbA1c-derived measures have gained attention as practical screening tools. Objectives: To comparatively evaluate the diagnostic performance of HbA1c-derived indices and fasting-based indices (HOMA-IR and TyG index) for detecting insulin resistance in hypertensive patients. Materials and Methods: This hospital-based cross-sectional analytical study included 160 adult hypertensive patients. Fasting blood samples were collected for estimation of plasma glucose, insulin, lipid profile, and HbA1c. Insulin resistance was defined using HOMA-IR ≥2.5 as the reference standard. The TyG index was calculated using fasting triglyceride and glucose values. Statistical analysis included correlation analysis and receiver operating characteristic curve analysis to evaluate diagnostic performance. Sensitivity, specificity, and area under the curve were calculated. A p-value <0.05 was considered statistically significant. Results: Insulin resistance was detected in 48.8% of patients using HOMA-IR. Insulin-resistant hypertensive patients had significantly higher BMI, waist circumference, blood pressure, triglyceride levels, fasting glucose, fasting insulin, HbA1c, and TyG index compared to non-insulin-resistant patients (p <0.05). TyG index demonstrated the highest diagnostic accuracy (AUC = 0.81), followed by HbA1c (AUC = 0.74) and fasting glucose (AUC = 0.68). HbA1c showed a significant positive correlation with HOMA-IR and TyG index and demonstrated acceptable sensitivity and specificity for identifying insulin resistance. Conclusion: TyG index showed superior diagnostic performance for detecting insulin resistance in hypertensive patients. However, HbA1c-derived measures demonstrated clinically acceptable accuracy and may serve as a simple and accessible screening tool in routine clinical practice. Combined use of HbA1c and fasting indices may improve early detection and risk stratification in hypertensive populations.
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Research Article
Open Access
Changing Trends of Bacterial and Fungal Corneal Ulcers in North India: A Retrospective Study
Dr. Pyoosh Kumar Pandey
,
Dr. Roma Goyal
,
Dr. Anil Kumar
Pages 83 - 86

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Abstract
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Ocular infections remain a major cause of outpatient visits and preventable visual impairment in developing countries. Recent Indian data suggest a rising trend of microbial keratitis and fungal infections, particularly in northern regions. This study aims to determine the demographic profile, clinical spectrum, microbiological pattern, and current prevalence trends of ocular infections among patients attending a tertiary care centre in North India. A prospective observational study was conducted over 18 months in the Department of Ophthalmology of a tertiary care teaching hospital in North India. All clinically diagnosed infectious ocular cases presenting to the outpatient department were included. Demographic data, risk factors, clinical findings, and microbiological investigations (Gram stain, KOH mount, bacterial and fungal cultures) were recorded. Data were analyzed using descriptive statistics. Ocular infections accounted for 20.4% of total ophthalmology outpatient visits. A total of 648 patients were included. The most affected age group was 21–40 years (35.8%), with male predominance (59.6%). Conjunctivitis was the most common presentation (40.2%), followed by microbial keratitis (32.1%). Culture positivity was 71.8%. Bacterial isolates constituted 53.6%, while fungal isolates accounted for 42.7%. Ocular trauma (33.5%) and prior topical steroid use (17.9%) were major risk factors. Ocular infections remain a significant contributor to ophthalmic morbidity in North India. Although conjunctivitis is most prevalent, microbial keratitis—particularly fungal—is increasing. Strengthening microbiological surveillance and regulating irrational steroid use are essential to reduce vision-threatening complications.
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Research Article
Open Access
FUNCTIONAL OUTCOME OF CONSERVATIVELY MANAGED DIAPHYSEAL FRACTURE OF BOTH BONE FOREARM IN PAEDIATRIC POPULATION
Dr. Krishnamurthy Y
,
Dr. Boddeti Veera Venkata Satyanarayana
,
Dr. D. Santhosh Karunakar
Pages 78 - 82

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Abstract
Pediatric diaphyseal fractures of both the radius and ulna are common injuries, and optimal management remains debated due to variations in remodeling potential and fracture stability. Conservative treatment continues to be widely used, but its functional outcomes require ongoing evaluation. Methods:A prospective study was conducted on 30 children aged 4–14 years with closed diaphyseal both-bone forearm fractures treated by closed reduction and above-elbow casting. Patients were followed at regular intervals for six months with serial radiographs to monitor angulation and clinical assessment of forearm rotational arcs. Final functional outcomes were graded based on rotational loss. Results: The majority of fractures involved the middle third of the forearm (56.66%). Early angulation increased slightly due to cast settling but demonstrated progressive correction through remodeling by six months. Among the 27 children completing conservative management, 51.85% achieved excellent outcomes, 33.33% good, and 14.81% fair, with no poor outcomes recorded. Three cases with early loss of reduction required surgical conversion.
Conclusion: Closed reduction and casting provide reliable functional and radiological outcomes for most pediatric diaphyseal forearm fractures when alignment and cast quality are closely monitored. Conservative management remains an effective first-line modality, with surgical intervention reserved for cases demonstrating early instability or failure to maintain acceptable reduction.
Research Article
Open Access
PREVALENCE OF ANTIBIOTIC RESISTANCE IN PEDIATRIC RESPIRATORY TRACT INFECTIONS: A SYSTEMATIC REVIEW
Dr Neha Agrawal
,
Dr Shikha Gupta
,
Dr Vineet Jain
,
Dr Ram Kshitij Sharma
Pages 72 - 77

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Abstract
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Abstract
Background: Pediatric respiratory tract infections (RTIs) remain among the most common reasons for antibiotic exposure worldwide, creating selective pressure for antimicrobial resistance (AMR). AMR increases the risk of treatment failure, complications, and downstream healthcare utilization. Objectives: To synthesize contemporary peer-reviewed evidence on the prevalence and patterns of antibiotic resistance among major pediatric RTI bacterial pathogens, and to summarize evidence-informed strategies that may reduce avoidable antibiotic exposure. Methods: A systematic review was conducted following PRISMA 2020 guidance. We searched PubMed/MEDLINE, Scopus, and Embase for peer-reviewed studies and systematic reviews reporting antimicrobial susceptibility in pediatric RTIs (upper and lower RTIs) and/or pediatric carriage studies relevant to RTI pathogens. Eligible studies included children (0–18 years) with RTIs or relevant respiratory carriage, and reported resistance proportions to commonly used antibiotic classes. Findings were narratively synthesized with emphasis on multi-region evidence and high-sample studies. Results: Evidence consistently shows substantial resistance in Streptococcus pneumoniae affecting β-lactams and macrolides, with high multidrug resistance in some settings. In US pediatric isolates, resistance to ≥1 drug class was 56.8% and macrolide resistance 39.9%. In Latin American invasive isolates, approximately one-quarter displayed penicillin resistance. Macrolide-resistant Mycoplasma pneumoniae (MRMP) displayed marked regional differences, reaching 53.4% in the Western Pacific region, and 37.0% in child-only studies. Haemophilus influenzae resistance remains clinically relevant in otitis-linked cohorts and infant carriage surveillance. Conclusions: Pediatric RTI pathogens show clinically meaningful resistance to first-line agents in multiple regions, necessitating guideline-concordant empiric therapy informed by local data, and strengthened stewardship and diagnostic strategies to reduce unnecessary antibiotic use.
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Research Article
Open Access
Comparison of Haemodynamic Stability and efficacy of Analgesia with General Anaesthesia and Segmental Spinal Anaesthesia in Percutaneous Nephrolithotomy in Adults
Dr Shyam Sharma
,
Dr Yamini Gupta
Pages 68 - 71

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Abstract
: Percutaneous nephrolithotomy (PCNL) is the standard intervention for large renal calculi. General anaesthesia (GA) has traditionally been used; however, segmental spinal anaesthesia (SSA) has emerged as an alternative, potentially improving haemodynamic stability and postoperative analgesia. Objectives: To compare haemodynamic responses, analgesic efficacy, and perioperative outcomes of GA and SSA in adult patients undergoing PCNL. Methods: A prospective comparative design was adopted. Adult patients undergoing elective PCNL were allocated to GA or SSA groups. Intraoperative haemodynamic parameters,postoperative pain scores, opioid consumption, and recovery indices were assessed. Outcomes were interpreted against evidence from recent randomized trials and meta-analyses. Results: SSA demonstrated significantly lower intraoperative heart rate and mean arterial pressure fluctuations. Postoperative pain scores and opioid requirements were consistently lower in SSA cohorts. Time to ambulation and oral intake were shorter in SSA, while stone-free rates and surgical duration were comparable. No increase in serious adverse events was reported. Conclusion: Segmental spinal anaesthesia provides superior haemodynamic stability and improved postoperative analgesia compared with GA for PCNL, without compromising surgical efficacy. SSA represents a safe and effective anaesthetic alternative in appropriately selected adult patients.
Research Article
Open Access
Impact of Long-Term HbA1c Variability on Microvascular Complications in Older Adults with Type 2 Diabetes: A Systematic Review and Meta-Analysis
Anurag Kesarwani
,
Harshada Bhangale
,
Reetika Shrivastava
Pages 62 - 67

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Abstract
Type 2 diabetes mellitus (T2DM) is highly prevalent among older adults and is a major contributor to microvascular complications, including diabetic retinopathy, nephropathy, and neuropathy. While glycated hemoglobin (HbA1c) is the standard marker of long-term glycemic control, increasing evidence suggests that visit-to-visit HbA1c variability may independently influence the development of diabetes-related complications. However, data specifically addressing this association in geriatric populations remain limited. This systematic review and meta-analysis aimed to evaluate the relationship between long-term HbA1c variability and microvascular complications among individuals aged ≥65 years with T2DM. A comprehensive search of PubMed/MEDLINE, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception to January 2025. Observational cohort and case–control studies reporting HbA1c variability (standard deviation, coefficient of variation, variability independent of the mean, or average real variability) and adjusted effect estimates for microvascular outcomes were included. Eighteen studies comprising approximately 142,000 participants met inclusion criteria. Higher HbA1c variability was significantly associated with increased risk of diabetic retinopathy (pooled HR 1.28; 95% CI 1.15–1.42), nephropathy (pooled HR 1.34; 95% CI 1.20–1.50), and peripheral neuropathy (pooled OR 1.22; 95% CI 1.08–1.37). These associations persisted after adjustment for mean HbA1c and conventional risk factors. Moderate heterogeneity was observed across studies. The findings suggest that HbA1c variability is an independent predictor of microvascular complications in geriatric patients with T2DM. Emphasizing glycemic stability, in addition to achieving target HbA1c levels, may improve complication risk stratification and management in older adults. Further prospective studies focusing exclusively on elderly populations are warranted to refine these associations and inform clinical guidelines.
Research Article
Open Access
Early Postoperative Macular Thickness Changes After Uncomplicated Small Incision Cataract Surgery: A Comparative Optical Coherence Tomography Study in Diabetic and Non-Diabetic Patients
Ridhima
,
Rakesh
Kumar
Gupta
Pages 50 - 54

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Abstract
Background: Cataract surgery is a routine procedure in patients with diabetes, yet the influence of diabetes on postoperative ocular outcomes, including macular thickness and the incidence of macular edema, remains inadequately understood. Methods: A prospective study was undertaken among diabetic and non-diabetic individuals undergoing small incision cataract surgery at the Department of Ophthalmology, MM Medical College, Solan. The study cohort comprised 100 participants, with demographic data, comorbidities, blood sugar parameters, severity of retinopathy, and ocular outcomes assessed both preoperatively and at 12 weeks post-surgery. Results: Retinopathic changes were exclusively identified in diabetic patients, underscoring the heightened vulnerability of diabetic individuals to ocular complications. Mild non-proliferative diabetic retinopathy (NPDR) was observed in 36% (n=18) of diabetic participants, followed by moderate NPDR, affecting 30% (n=15) of individuals. Postoperative analysis revealed a notable increase in macular thickness in both diabetic and non-diabetic groups, with a more pronounced elevation observed among diabetic patients (p-value = 0.036). Furthermore, diabetic participants exhibited a significantly higher incidence of macular edema compared to their non-diabetic counterparts (p= 0.046). Conclusion: This study underscores the critical necessity for meticulous preoperative evaluation and diligent postoperative surveillance in diabetic patients undergoing cataract surgery. Healthcare practitioners should remain vigilant for signs of macular thickening and edema in diabetic patients to prevent potential vision-threatening consequences.
Research Article
Open Access
AWARENESS ABOUT ANESTHESIA TECHNIQUES AND ANESTHESIOLOGISTS IN PATIENTS AND ATTENDANTS COMING TO A TERTIARY CARE HOSPITAL
Palak Ahir
,
Abhilasha Motghare
,
Charmi Bhimbha
,
Aakanksha Raval
,
Pratik Savalia
,
Urvisha Avchar Mendpara
Pages 46 - 49

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Abstract
Background: Anaesthesiology is a vital specialty extending beyond the operation theatre; however, public awareness regarding anaesthesia techniques and the role of anaesthesiologists remains limited. Inadequate knowledge may contribute to preoperative anxiety and reduced participation in shared decision-making. This study aimed to assess awareness about anaesthesia techniques and anaesthesiologists among patients and attendants attending a tertiary care hospital in Western India. Materials and Methods: This cross-sectional study was conducted in the Outpatient Department of a tertiary care hospital over six months after Institutional Ethics Committee approval. Participants aged 18–60 years were enrolled after verbal informed consent. A validated 22-item questionnaire assessing demographic details, knowledge of anaesthesiologists, and awareness of anaesthesia techniques was administered through personal interviews. Data were analyzed using descriptive statistics and expressed as proportions and percentages. Results: A total of 384 participants were included. Although 62.76% correctly identified both general and regional anaesthesia techniques and 71.09% recognized that general anaesthesia can involve both inhalational and intravenous agents, only 9.63% identified anaesthesiologists as physicians, while 44.79% perceived them as assistants to surgeons. Awareness of roles beyond the operation theatre, particularly in ICU and pain clinics, was limited. Notably, 61.19% were unaware of anaesthesia-related complications. Encouragingly, 77.60% expressed willingness to receive detailed information from an anaesthesiologist prior to surgery. Conclusion: Despite partial awareness of anaesthesia techniques, significant gaps persist regarding the comprehensive role of anaesthesiologists. Strengthening patient education and implementing structured shared decision-making in preoperative counselling may enhance patient understanding, autonomy, and perioperative care outcomes
Research Article
Open Access
“Radiological and Functional Outcomes of Geriatric Intertrochanteric Femur Fractures Treated with Proximal Femoral Nail Antirotation (Asian): A Prospective Case Series”
Dr. Ganesh Ram. S
,
Dr. Sriram. S
,
Dr. Kannan. R.M
,
Dr. Ramasamy. R
Pages 38 - 45

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Abstract
A Geriatric intertrochanteric femur fractures represent a major cause of morbidity and functional decline. Stable fixation allowing early mobilization is essential. The Proximal Femoral Nail Antirotation (PFNA) Asian system was designed to improve fixation in osteoporotic bone and to accommodate femoral morphology in Asian populations. Methods: This prospective case series evaluated geriatric patients with intertrochanteric femur fractures treated using PFNA Asian between July 2021 and July 2024 at a tertiary care orthopedic center. Radiological union, implant positioning parameters, functional outcomes using the Harris Hip Score (HHS) and Parker–Palmer Mobility Score, and complications were assessed at serial minimum follow-up of 12 months. Results: Fracture union was achieved in the majority of patients within the expected timeframe. Functional outcomes were predominantly good to excellent. Accurate reduction and optimal blade positioning were significantly associated with superior outcomes. Conclusion: PFNA Asian provides reliable fixation with favorable radiological and functional outcomes in geriatric intertrochanteric fractures when sound surgical principles are followed.
Research Article
Systematic review and meta-analysis on Association between HbA1c variability and microvascular complications in Type 2 diabetes among Geriatric Population
Marripalepu Venkata Kamalakar
,
Ravita Kumari
,
Shobana B
Pages 27 - 37

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Abstract
Type 2 diabetes mellitus (T2DM) in older adults is frequently complicated by microvascular complications that contribute to significant morbidity. While mean glycated hemoglobin (HbA1c) is the standard marker of long-term glycemic control, increasing evidence indicates that long-term visit-to-visit HbA1c variability may independently influence complication risk. This systematic review and meta-analysis evaluated the association between HbA1c variability and microvascular complications in patients with T2DM, with particular emphasis on the geriatric population. A comprehensive search of major electronic databases was conducted up to June 2025. Thirty-six studies were included in the qualitative synthesis, and 18 studies were eligible for meta-analysis. Higher HbA1c variability was consistently associated with an increased risk of diabetic nephropathy and retinopathy, independent of mean HbA1c levels. Evidence for diabetic neuropathy was more limited but suggested a similar trend. Although geriatric-specific data were scarce, available studies indicated that older adults remain vulnerable to the adverse effects of glycemic variability. These findings highlight the clinical relevance of HbA1c variability in predicting microvascular risk in T2DM.
Research Article
Open Access
Retrospective Analysis of Antibiotic Resistance Patterns in Bacterial Infections
Dr Anish Lal
,
Dr Swati Sharan
,
Dr (Prof) Pratulya Nandan
Pages 21 - 26

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Abstract
Ac Antimicrobial resistance (AMR) has emerged as a major global health challenge, threatening the efficacy of standard treatments and increasing the risk of morbidity and mortality. Hospital-based surveillance studies are essential for understanding local resistance patterns and guiding empirical therapy. Methods: A retrospective observational study was conducted in the Department of Microbiology, PMCH, from January 2025 to June 2025. A total of 90 non-duplicate clinical isolates, including urine, pus, blood, sputum, and wound swabs, were analyzed. Standard microbiological methods identified bacteria, and CLSI 2025-compliant Kirby-Bauer disc diffusion tested antibiotic susceptibility. Results: Among the 90 isolates, Escherichia coli (30.0%) and Klebsiella pneumoniae (20.0%) were the most frequent, followed by Pseudomonas aeruginosa (12.2%), Staphylococcus aureus (16.7%), and Enterococcus spp. (6.7%), and Acinetobacter baumannii (7.8%). Resistance to cephalosporins was high in E. coli (66.7%) and Klebsiella (72.2%), while fluoroquinolone resistance reached 70.0% in E. coli and 66.7% in Klebsiella. Carbapenem resistance was observed in Klebsiella (33.3%) and Acinetobacter (57.1%). MRSA accounted for 46.7% of S. aureus isolates. Despite widespread resistance, vancomycin and linezolid remained effective against gram-positive isolates, and amikacin showed moderate activity (50–60% sensitivity) against gram-negatives. Overall, 38.9% of isolates met the definition of MDR. Conclusion: The findings underscore the urgent need for continuous surveillance of resistance trends at PMCH, along with the implementation of robust antibiotic stewardship programs and infection control measures. Local resistance data should guide empirical prescribing practices to preserve the efficacy of last-line antibiotics.
Research Article
Open Access
Comparison of Different Diagnostic Methods for Detecting Infectious Diseases: Culture, PCR, and Serology
Dr Shimona Kirti
,
Dr Spriha Smriti
,
Dr (Prof) Pratulya Nandan
,
Dr (Prof) Vijay Kumar
Pages 16 - 20

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Abstract
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Abstract
Background: Accurate and timely diagnosis of infectious diseases is critical for effective treatment, infection control, and improved patient outcomes. Conventional culture methods, Polymerase Chain Reaction (PCR), and serology are commonly used diagnostic approaches, each with distinct advantages and limitations. Methods: A prospective observational study was conducted from January 2025 to June 2025, including 100 adult patients presenting with clinical signs of infection. Specimens such as blood, urine, and swabs were collected and tested using culture, PCR, and serological assays. Outcome measures included sensitivity, specificity, Positive Predictive Value (PPV), Negative Predictive Value (NPV), accuracy, and turnaround time. Statistical analysis was performed using SPSS, with significance set at p < 0.05. Results: PCR demonstrated the highest sensitivity (95%) and negative predictive value (96%), detecting additional cases missed by culture. Culture showed perfect specificity (100%) and positive predictive value (100%), confirming its role as the gold standard. Serology provided intermediate sensitivity (87%) and specificity (85%), proving valuable as a supplementary tool. PCR had the fastest turnaround time (4–6 hours), compared to serology (6–12 hours) and culture (48–72 hours). Conclusion: PCR offers rapid and highly sensitive detection, culture provides definitive confirmation, and serology serves as an adjunct, particularly in viral or systemic infections. Combining these methods optimizes diagnostic accuracy and patient management. Future research should focus on multicenter studies, larger sample sizes, and integration of rapid molecular techniques to enhance infectious disease diagnostics.
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Research Article
Open Access
Evaluation of the Effectiveness of Microbiological Testing in Monitoring Environmental Contamination
Dr Prachi
,
, Dr Spriha Smriti
,
Dr (Prof) Pratulya Nandan
,
Dr (Prof) Vijay Kumar
Pages 10 - 15

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Abstract
Environmental contamination in hospital settings is a major contributor to Hospital-Acquired Infections (HAIs), posing significant risks to patients and healthcare workers. Effective monitoring of microbial contamination is essential to guide infection prevention strategies. Methods: A prospective observational study was conducted from January to June 2025. A total of 80 environmental samples, including surface swabs, air, and water samples, were collected from high-touch areas and critical hospital zones. Microbiological testing was performed using culture-based methods, with bacterial and fungal species identified and quantified in Colony-Forming Units (CFU). Data were analyzed to assess contamination patterns, differences across wards, surfaces, and temporal trends. Results: Of the 80 samples, 52 (65%) were positive for microbial growth. Surface swabs showed the highest contamination, followed by water and air samples. Predominant microorganisms included Staphylococcus aureus, Pseudomonas aeruginosa, Escherichia coli, Klebsiella spp., and Candida albicans. ICUs and high-touch surfaces exhibited the highest microbial load. Temporal analysis revealed fluctuations in contamination over the six months. Conclusion: Microbiological testing is an effective tool for monitoring environmental contamination and guiding targeted infection control interventions. Routine surveillance of high-risk areas is recommended to reduce HAIs and enhance patient safety.
Research Article
Open Access
Is Type II Diabetes Mellitus Influenced by the Blood Group? A Cross-Sectional Study from South Kashmir
Mehak Mufti
,
Yusra Amin
,
Mubashir Bashir
Pages 6 - 9

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Abstract
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Abstract
Background: Type 2 diabetes mellitus (T2DM) is a rapidly growing public health problem with a strong genetic component, particularly among South Asian populations. In recent years, the ABO blood group system has been explored as a potential biological factor influencing susceptibility to various metabolic disorders, including diabetes mellitus. However, evidence from Indian populations, especially from the Kashmir region, remains limited and inconclusive. Objectives: To assess the association between ABO blood groups and type 2 diabetes mellitus and to identify blood groups that may be more or less prone to developing the disease. Materials and Methods: This descriptive cross-sectional study was conducted at Government Medical College Anantnag and its associated hospital over six months. A total of 300 confirmed cases of T2DM attending outpatient and inpatient services were included after informed consent. Demographic details, duration of diabetes, and comorbidities were recorded. ABO and Rh blood grouping was performed using the slide (direct) method. Data were analyzed descriptively. Results: Of the 300 participants, 53.7% were female and 46.3% were male. Most patients belonged to the 31–60-year age group (61%). Blood group B⁺ was the most prevalent among diabetic patients (31.7%), followed by A⁺ (23.7%) and O⁺ (18.3%), while the lowest prevalence was observed in A⁻ and AB⁻ groups (1.3% each). The majority of participants (65%) had a duration of diabetes of less than five years. Conclusion: The study demonstrates a higher prevalence of type 2 diabetes mellitus among individuals with blood group B, suggesting a possible association between ABO blood group and susceptibility to T2DM. Blood group B may represent a potential genetic risk marker. Larger multicentric and molecular-level studies are required to further elucidate this relationship.
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Research Article
Open Access
Corelation of the Glycaemic Parameters and Serum Vitamin D₃ Levels in Patients with Diabetes Mellitus: A Case-Control Study
Saima Mushtaq
,
Yusra Amin
,
Shah Yasir Yousuf
Pages 1 - 5

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Abstract
Abstract
Background: Type 2 diabetes mellitus (T2DM) is a chronic metabolic disorder characterized by persistent hyperglycaemia resulting from insulin resistance and progressive β-cell dysfunction. Vitamin D₃ has emerged as a potential modulator of glucose metabolism through its effects on insulin secretion, insulin sensitivity, and inflammation. However, the association between serum vitamin D₃ levels and glycaemic indices remains inconsistent across populations. The present study aimed to evaluate serum vitamin D₃ levels in patients with T2DM and to assess their relationship with fasting blood sugar (FBS) and glycated haemoglobin (HbA1c), in comparison with healthy controls. Methods: This case–control study was conducted over six months at Government Medical College Anantnag and included 50 confirmed T2DM patients and 50 age-matched healthy controls. Fasting venous blood samples were collected for estimation of FBS, HbA1c, average blood glucose (ABG), and serum vitamin D₃ levels using standard laboratory methods. Data were analysed using SPSS software. Group comparisons were performed using the independent Student’s t-test, and correlations were assessed using Pearson’s correlation coefficient. A p-value <0.05 was considered statistically significant. Results: Diabetic patients demonstrated significantly higher mean HbA1c (7.62 ± 1.64% vs 5.03 ± 0.50%), FBS (134.92 ± 42.61 mg/dL vs 87.30 ± 7.37 mg/dL), and ABG (158.20 ± 62.07 mg/dL vs 93.76 ± 11.75 mg/dL) compared to controls (p <0.001). Serum vitamin D₃ levels also differed significantly between groups (p <0.001). In diabetic patients, vitamin D₃ levels showed a statistically significant correlation with HbA1c (r = 0.497, p = 0.00024), whereas no significant correlation was observed in healthy controls. Notably, 52% of diabetic patients were vitamin D₃ deficient. Conclusion: The study demonstrates a significant association between serum vitamin D₃ levels and glycaemic control in patients with T2DM. Hypovitaminosis D was highly prevalent among diabetics and correlated with poor glycaemic indices, particularly HbA1c. These findings suggest that vitamin D₃ status may influence glycaemic regulation in individuals with underlying metabolic dysfunction, warranting further investigation into its potential role in diabetes management.