Introduction: Stress is an unavoidable part of daily life that causes people to face unpleasant conditions that activates various local and systemic physiological pathways, such as brain networks and hormone systems. Many dietary changes are used to mitigate its effects on the human body. The current study aims to determine and correlate serum levels of cortisol and betatrophin in rats fed on conventional lab diet, probiotics, and Synbiotic while subjected to the stressors of immobilisation and fasting. A randomised control trial was conducted at IIMC and NIH. A total of 50 male Sprague Dawley rats were chosen and divided into four experimental groups B1, B2, B3, and B4 (10 rats each). They were subjected to the stressors of immobilisation (2 hours/5 days/10 weeks) and fasting (10 hours/5 days/10 weeks), with Group B1 subjected to an extra 2 hours of fasting. Standard lab food was given to groups B1 and B2. Standard lab diet with Probiotics was provided to Group B3 and Standard lab diet with Synbiotic was given to Group B4. Blood samples were obtained at weeks 0, 4, and 10 to determine serum cortisol and betatrophin levels. The data was reported as Mean± S.D, with p≤0.05 was considered significant. After a 10-week trial, Group B4 had significantly lower serum levels of cortisol and betatrophin than the other groups. In this group, there was also a positive correlation between serum cortisol and betatrophin. The findings revealed that synbiotics played a major effect in improving cortisol and betatrophin levels in stressed rats.

Introduction: Polycystic ovary syndrome is a common endocrine disorder among reproductive-age women and is strongly associated with metabolic abnormalities including obesity, insulin resistance, and diabetes mellitus. Objective: To determine the frequency of polycystic ovary syndrome with diabetes mellitus and obesity among reproductive-age women presenting to tertiary care hospitals in Pakistan. Methods: This cross-sectional analytical study was conducted at Tertiary Care Hospital in Islamabad from March 2024 to September 2025, including 375 reproductive-age women presenting with reproductive or endocrine-related complaints. Results: The mean age of participants was 28.9 ± 6.4 years, with mean BMI of 29.7 ± 5.8 kg/m². Confirmed PCOS was identified in 156 (41.6%) women, diabetes mellitus in 88 (23.5%), and obesity in 171 (45.6%). PCOS with diabetes was present in 61 (16.3%), PCOS with obesity in 103 (27.5%), and combined PCOS with both diabetes and obesity in 47 (12.5%) participants. Women with PCOS had significantly higher BMI (32.1 ± 5.4 vs. 28.0 ± 4.9 kg/m²; p<0.001), greater waist circumference (98.3 ± 10.4 vs. 88.2 ± 9.7 cm; p<0.001), and higher diabetes prevalence (39.1% vs. 12.3%). Menstrual irregularity was the strongest predictor of PCOS (aOR 5.84; p<0.001), followed by obesity (aOR 4.68), hirsutism (aOR 4.11), and diabetes mellitus (aOR 3.92). Conclusion: PCOS is highly prevalent among symptomatic reproductive-age women in tertiary care settings and shows strong association with obesity and diabetes mellitus, highlighting the importance of integrated endocrine-metabolic screening..

Background: Fear of childbirth (FOC) is also a major psychological issue for pregnant women and can negatively influence their health, childbirth experience and request for cesarean section (CS). Previous birth experiences, especially traumatic or negative experiences are known as significant factors in maternal fear for upcoming pregnancies. An appreciation of the association between previous birth experiences and fear of childbirth is necessary to develop better counselling and obstetric practice. Objective: To find out the effect of previous birth experience on maternal fear of childbirth among pregnant women admitted in tertiary care hospitals in Karachi. Material and Methods: The cross sectional study was done in two multi-centers namely Creek General Hospital and SESSI Landhi Hospital, Karachi. Pregnant women who visited antenatal clinics during the study period and had 2 or more previous births were included in the study. A structured questionnaire consisting of demographic data, obstetric history, previous birth experience and fear of childbirth assessment was used for data collection. Previous birth experience was classified as positive or negative according to mother's perception of labor and delivery, pain, communication with health care staff or obstetric complications. A validated fear assessment scale was used to assess maternal fear of childbirth. SPSS version 26 was used to analyses the data. Categorical variables were presented as frequency and percentages and continuous variables as mean and standard deviation. Association of previous birth experience with fear of childbirth was analyzed and a p value of ≤0.05 was considered statistically significant. Results: The total number of pregnant women included in the study were 200. The average age of the participants was 28.6 ± 4.9 years. Of the participants, 42% had a negative previous birth experience and 58% had positive previous birth experiences. 46.5% of women had moderate or great fear of childbirth. For those women having a negative previous birth experience, the mean score for fear of childbirth was significantly higher than women with positive previous birth experience (68.1% vs. 30.2%, p < p<0.001). Previous cesarean section, long labor, insufficient pain management, and communication issues with healthcare providers were all factors that were significantly associated with an increased fear. Conclusion: Previous negative birth experiences are highly correlated with greater fear of childbirth for a mother in subsequent births. However, early identification of women who have had traumatic or suboptimal previous deliveries and provision of psychological support, effective counselling and respectful maternity care may help to decrease fear of childbirth and improve maternity outcomes.

Introduction: The 5-factor modified frailty index (mFI-5) is a validated, easily calculable preoperative risk stratification tool. However, its utility in predicting postoperative morbidity following total knee arthroplasty (TKA) in the Indian population remains understudied. Methods: A retrospective analysis of 99 consecutive patients who underwent primary TKA at Sapthagiri Institute of Medical Sciences and Research Centre, Bengaluru, between January 2023 and January 2026 was conducted. The mFI-5 was calculated using five variables: diabetes mellitus, hypertension, congestive heart failure (CHF), chronic obstructive pulmonary disease (COPD), and functional dependence. Patients were stratified as non-frail (mFI 0–1), moderately frail (mFI 2), or severely frail (mFI ≥3). Primary outcomes included postoperative complications, ICU admission, 30-day readmission, and 30-day mortality. Secondary outcomes included length of hospital stay (LOS) and 3-month Knee Society Score (KSS).

Results: Mean age was 64.7 ± 7.6 years; 58.6% were female. mFI-5 scores ranged from 0 to 4: 56 patients (56.6%) were non-frail, 35 (35.4%) moderately frail, and 8 (8.1%) severely frail. Postoperative complications occurred in 0%, 11.4%, and 62.5% of non-frail, moderately frail, and severely frail patients respectively (p<0.001). ICU admission rates were 7.1%, 22.9%, and 37.5% (p=0.023). Thirty-day readmission rates were 0%, 11.4%, and 62.5% (p<0.001). Frail patients (mFI ≥2) had a 4.47-fold higher odds of ICU admission compared to non-frail patients. Mean LOS was significantly longer with increasing frailty (5.5 vs 6.1 vs 8.6 days; p<0.001). No 30-day mortality was recorded. Functional outcomes at 3 months did not differ significantly between groups (p=0.136).

Conclusion: The mFI-5 is a simple, effective preoperative tool for predicting postoperative morbidity, ICU admission, and 30-day readmission following TKA. Increasing frailty is associated with significantly higher complication rates and prolonged hospital stay. Routine preoperative mFI-5 assessment should be integrated into TKA surgical planning, particularly in resource-limited settings

Introduction: COVID‑19 has imposed an unprecedented global burden, with millions of deaths worldwide. Emerging evidence suggests that pre‑existing comorbidities may influence disease severity and prognosis, yet findings remain heterogeneous across populations. Understanding the independent impact of specific comorbidities is essential for risk stratification and clinical management.

Aim: To evaluate the prognosis of COVID‑19 in patients with exclusive comorbidities—type 2 diabetes mellitus, hypertension, or autoimmune disease—and to compare outcomes with patients without comorbidities. Methods: A retrospective comparative study was conducted at Bowring and Lady Curzon Hospital, Bengaluru, between October 2020 and February 2022. Case records of 224 COVID‑19‑positive patients aged 18–60 years were reviewed. Patients were categorized into five groups: diabetes mellitus, hypertension, autoimmune disease, HIV/AIDS, and non‑comorbid controls. Clinical outcomes, including mortality and duration of hospital stay, were analyzed using chi‑square and z‑tests, with p < 0.05 considered statistically significant. Results: Of the 224 patients, 79 had no comorbidities, 80 had diabetes mellitus, 60 had hypertension, 5 had autoimmune disease, and 5 had HIV/AIDS. Mortality was significantly higher in diabetic patients compared to controls (60 % vs 12.5 %, p = 0.0003). Hypertension (25 %), autoimmune disease (40 %), and HIV/AIDS (40 %) groups showed numerically increased mortality but without statistical significance (p = 0.06, p = 0.09, and p = 0.11, respectively). Mean hospital stay did not differ significantly across groups. Conclusion: Type 2 diabetes mellitus was associated with significantly poorer outcomes in COVID‑19 patients, while hypertension and autoimmune disease demonstrated more heterogeneous associations. These findings underscore the importance of comorbidity‑specific risk stratification and highlight the need for larger, multicentric studies to clarify the independent contributions of other comorbidities.

Introduction: Hypertension is the most prevalent modifiable cardiovascular risk factor among older adults and a major contributor to cerebrovascular disease. Poor blood pressure control is strongly associated with stroke and cognitive decline, yet the extent of neurological benefit derived from effective hypertension management in the elderly remains underexplored in routine clinical settings. Objectives: To assess the impact of hypertension management on neurological health outcomes, including stroke and cognitive impairment, among adults aged 60 years and above. Methods:
This observational analytical study was conducted over 12 months at a tertiary care teaching hospital and included 220 hypertensive adults aged ≥60 years. Participants were categorized into controlled and uncontrolled hypertension groups based on average blood pressure readings (<130/80 mmHg). Neurological outcomes assessed included history of stroke, cognitive function, and overall neurological morbidity. Cognitive status was evaluated using standardized screening tools. Multivariable logistic regression was performed to determine independent associations after adjusting for relevant confounders. Results:
Among the participants, 56.4% had controlled hypertension. Overall neurological morbidity was significantly lower in the controlled hypertension group compared to the uncontrolled group (19.4% vs. 39.6%, p < 0.001). Stroke prevalence was significantly reduced among participants with controlled blood pressure (11.3% vs. 25.0%, p = 0.006). Cognitive impairment was observed in 24.2% of the controlled group compared to 45.8% of the uncontrolled group (p = 0.002). Uncontrolled hypertension independently predicted neurological morbidity (adjusted OR 2.31; 95% CI: 1.34–3.98), stroke (adjusted OR 2.08; 95% CI: 1.12–3.87), and cognitive impairment (adjusted OR 1.89; 95% CI: 1.10–3.25). High medication adherence was associated with improved blood pressure control and significantly lower neurological morbidity. Conclusion:
Effective hypertension management is strongly associated with reduced risk of stroke, cognitive impairment, and overall neurological morbidity in older adults. Sustained blood pressure control and optimal medication adherence play a crucial role in preserving neurological health and preventing cerebrovascular events in aging populations.

This study looks into factors that predict heavy menstrual bleeding (HMB) in women taking letrozole and clomiphene citrate (CC) to induce ovulation. The quality of life of patients is impacted by HMB, a serious side effect of modern fertility treatments. Finding clinical, genetic, and demographic characteristics linked to HMB was the goal of the study.This study was conducted in Fatima Hospital, Baqai Medical University Karachi from January 2025 till june  2025  .Two hundred women between the ages of 18 and 40 participated in the observational comparative design. We gathered information on genetic variants (CYP19A1), age, BMI, and baseline hormone levels. The findings showed that compared to letrozole (18%), clomiphene was linked to a greater incidence of HMB (63%). Higher BMI, certain genetic variants, and greater baseline estrogen were found to be significant predictors of HMB using logistic regression. A safer profile was demonstrated by letrozole, particularly in PCOS patients. The results emphasize the necessity of customized ovulation induction procedures to maximize therapeutic benefits and minimize adverse consequences. To improve fertility treatment even further, future research should include lifestyle changes and genetic testing.

Background: Chronic pruritus is common in elderly patients and may arise from dermatological, systemic, drug-related, neuropathic, psychogenic, or idiopathic causes. This study assessed its prevalence, etiological factors, and clinical burden among elderly patients at a tertiary care centre. Methods: This prospective observational study included 300 patients aged ≥60 years from 1 August 2025 to 1 May 2026. Chronic pruritus was defined as itching lasting more than six weeks. Clinical features, comorbidities, etiological factors, pruritus severity, sleep disturbance, and Dermatology Life Quality Index scores were assessed. Results: Chronic pruritus was present in 128 patients, with a prevalence of 42.7% (95% CI 37.2%–48.3%). Most cases had generalized pruritus (62.5%), moderate-to-severe intensity (87.5%), nocturnal predominance (53.9%), and sleep disturbance (45.3%). Dermatological causes were most common (37.5%), followed by systemic (21.9%), mixed (16.4%), idiopathic (11.7%), drug-related (5.5%), neuropathic (3.9%), and psychogenic causes (3.1%). Xerosis was present in 62.5% of chronic pruritus cases. On multivariable analysis, increasing age, xerosis, polypharmacy, diabetes mellitus, and chronic kidney disease were independently associated with chronic pruritus. Pruritus severity was strongly associated with higher DLQI scores, sleep disturbance, and large/very large quality-of-life impairment. Conclusion: Chronic pruritus was highly prevalent among elderly patients and was mainly associated with xerosis, chronic kidney disease, diabetes mellitus, polypharmacy, and increasing age. Its strong impact on sleep and quality of life supports structured evaluation and targeted management.

Background: Patients with chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD) undergoing cardiothoracic surgery face elevated risks of prolonged mechanical ventilation (PMV). However, the comparative impact of these phenotypes and their independent predictors remain poorly characterized. This systematic review and meta-analysis aims to synthesize evidence on PMV predictors specifically in COPD and ILD populations Methods: We systematically searched PubMed/MEDLINE, Embase, Cochrane Central Register of Controlled Trials, and Web of Science from inception through January 2026. Observational studies and randomized controlled trials reporting PMV predictors (>24 hours ventilation) in adult patients with COPD or ILD undergoing cardiothoracic surgery were included. Two independent reviewers extracted data and assessed study quality using the Newcastle-Ottawa Scale. Random-effects meta-analysis pooled odds ratios (OR) for identified predictors. Results: Of 3,847 citations screened, 47 studies met inclusion criteria (n=28,459 patients): 38 studies (n=19,234) on COPD, 6 studies (n=3,892) on ILD, and 3 studies (n=5,333) comparing both phenotypes. The pooled PMV rate was 32.1% (95% CI 28.4-36.0%) in COPD and 41.8% (95% CI 36.2-47.6%) in ILD patients.

Independent predictors of PMV in COPD: COPD severity (GOLD III-IV: OR 2.45, 95% CI 2.01-2.99, I²=42%), age >70 years (OR 1.78, 95% CI 1.54-2.06, I²=31%), cardiopulmonary bypass time >120 min (OR 2.31, 95% CI 1.95-2.74, I²=38%), FEV₁ <50% predicted (OR 2.12, 95% CI 1.76-2.55, I²=47%), and preoperative oxygen use (OR 1.58, 95% CI 1.32-1.89, I²=28%). Independent predictors of PMV in ILD: Cardiopulmonary bypass time >120 min (OR 2.67, 95% CI 2.14-3.33, I²=25%), age >70 years (OR 2.12, 95% CI 1.68-2.67, I²=19%), preoperative oxygen dependency (OR 2.45, 95% CI 1.98-3.03, I²=22%), and DLCO <40% predicted (OR 2.28, 95% CI 1.74-2.99, I²=31%). ILD vs COPD: ILD patients had significantly higher PMV risk (OR 1.68, 95% CI 1.42-1.99, I²=34%, p<0.001). Conclusions: COPD and ILD are both strong independent predictors of PMV after cardiothoracic surgery, with ILD conferring significantly higher risk. Phenotype-specific predictors include COPD severity and FEV₁ for COPD, and oxygen dependency and DLCO for ILD. These findings support tailored perioperative risk stratification and management strategies based on lung disease phenotype.

Introduction: Depression and perceived stress are common but frequently under-recognized mental health concerns among elderly individuals. Community-level assessment is essential for identifying vulnerable older adults and planning early supportive interventions. Objectives: To estimate the prevalence of depression and perceived stress among elderly individuals in a community setting and to assess the relationship between depression, perceived stress and selected socio-demographic and clinical variables. Methods: This community-based cross-sectional study was conducted among 100 elderly individuals aged 60 years and above from the Sangareddy population between November 2025 and March 2026. Socio-demographic details, living arrangement, marital status, education and chronic illness history were recorded using a structured proforma. Depression was assessed using the Geriatric Depression Scale and perceived stress was assessed using the Perceived Stress Scale. Data were analysed using descriptive statistics and chi-square test, with statistical significance considered at p < 0.05. Results: The mean age of the study population was 70.4 ± 7.1 years, and females constituted 52.0%. Depressive symptoms were present in 46.0% of participants. Mild depression was observed in 28.0%, moderate depression in 14.0% and severe depression in 4.0%. Moderate perceived stress was reported by 52.0%, while 25.0% had high perceived stress. Depression was significantly associated with advanced age, living alone, widowed/single/separated status, chronic illness and higher perceived stress. Conclusion: Depression and perceived stress were common among elderly individuals in this community setting. Screening older adults for psychological distress, especially those living alone or having chronic illness, can strengthen early identification and community-based mental health support.

Introduction: Steatotic liver disease (SLD) is a recently adopted umbrella term encompassing a spectrum of disorders characterized by hepatic steatosis. The new nomenclature replaces the traditional non-alcoholic fatty liver disease (NAFLD) framework and emphasizes the central role of metabolic dysfunction in disease pathogenesis. Aim: To evaluate the clinical profile of patients with steatotic liver disease and assess the distribution of cardiometabolic risk factors across various etiological categories. Methods: A prospective observational study was conducted in the Department of Medicine, Pt. B.D. Sharma PGIMS, Rohtak, Haryana, India. Two hundred consecutive patients diagnosed with steatotic liver disease on ultrasonography were enrolled over one year. Clinical characteristics, anthropometric measurements, biochemical parameters, imaging findings, and etiological classification were analyzed. Results: The mean age of the study population was 49.84 ± 15.45 years. Males constituted 52.5% of patients. Significant alcohol intake was reported in 26.5% of participants. BMI ≥23 kg/m² was observed in 76.0% of patients. Diabetes mellitus, hypertension, and dyslipidaemia were each present in 28.0% of cases. Hypertriglyceridaemia and low HDL cholesterol were observed in 59.5% and 67.0% of patients, respectively. MASLD was the predominant etiology (70.0%), followed by MetALD (16.0%), alcohol-related liver disease (9.5%), specific-etiology SLD (2.5%), and cryptogenic SLD (2.0%). Among MASLD patients, 21.4% fulfilled criteria for metabolic dysfunction-associated steatohepatitis (MASH). Conclusion: MASLD is the predominant form of steatotic liver disease in North Indian patients and demonstrates a strong association with obesity, dysglycaemia, hypertension, and dyslipidaemia. The contemporary SLD nomenclature effectively captures metabolic–alcohol overlap and provides a clinically meaningful framework for disease characterization.

Introduction: Transfusion of blood and blood components is always associated with a potential risk.Transfusion reaction means any transfusion related adverse event that occurs during or after the transfusion of whole blood, blood components, or human derived plasma products.Knowledge about various types of adverse transfusion reactions will help not only in their early identification and management but also in taking adequate measures to prevent the same. Aim&Objectives To study the frequency of adverse transfusion reactions of blood and blood components and to know the most common type of blood and blood components implicated in transfusion reaction. Materials and Methods: This  hospital based descriptive study was undertaken in the Department of Transfusion medicine, Government General Hospital and Medical College, Kadapa Andhra Pradesh, India over a period of one year i.e., from January 2023 to December 2023. Results: During 1 year study period, a total of 7498 blood and blood components were issued.The total number of transfusion reactions occurred were 48. In our study the frequency of transfusion reactions was found to be 0.20%. FNHTR(62.5%) is the most common type of transfusion reaction noted .Maximum reactions were seen in females (68.8%) and   occurred in the age group of 21-40 years (39.6%). Conclusion: Proper monitoring and knowledge of the signs and  symptoms of the ATRs help in the early identification of these reactions and hence timely management  and reporting.  It is the joint responsibility of the blood transfusion  consultant and their clinical counterpart to create awareness about safe transfusion services so that proper hemovigilance system can be achieved to  provide patient care. This study is an effort toward this direction.

Introduction: Elderly residents of long-term care facilities (LTCFs) experience high exposure to broad-spectrum antimicrobials, frequent hospital transitions, and prolonged shared accommodation — conditions that favour the acquisition and dissemination of multidrug-resistant organisms (MDROs). Robust pooled estimates of colonization burden are essential to inform infection prevention and control (IPC) policy in geriatric care. We synthesised the global evidence on the prevalence of MDRO colonization and its independent risk factors among LTCF residents. Methods: We performed a systematic review and meta-analysis in accordance with the PRISMA 2020 statement (PROSPERO: CRD42024456782). PubMed, Embase, Web of Science and Scopus were searched from inception to 31 December 2024 for observational studies reporting point prevalence of MDRO colonization (methicillin-resistant Staphylococcus aureus [MRSA], vancomycin-resistant enterococci [VRE], extended-spectrum β-lactamase-producing Enterobacterales [ESBL-E], carbapenem-resistant Enterobacterales [CRE], multidrug-resistant Pseudomonas aeruginosa and Acinetobacter baumannii, and Clostridioides difficile) among residents aged ≥65 years in LTCFs. Two reviewers independently performed selection, data extraction, and risk-of-bias appraisal using the Joanna Briggs Institute (JBI) checklist for prevalence studies. Pooled prevalence estimates were obtained using random-effects meta-analysis with the DerSimonian–Laird estimator after Freeman–Tukey double-arcsine transformation. Heterogeneity was quantified with the I² statistic and explored through pre-specified subgroup analyses and random-effects meta-regression. Publication bias was assessed visually (funnel plot) and statistically (Egger’s regression). Independent risk factors were summarised as pooled adjusted odds ratios (aORs). Results: Of 3,280 records identified, 42 studies were eligible for qualitative synthesis and 38 (n = 22,167 residents across 24 countries) for meta-analysis. The pooled prevalence of any MDRO colonization was 38.7% (95% confidence interval [CI]: 34.2–43.4%; I² = 87.1%). ESBL-producing Escherichia coli (28.7%, 95% CI: 24.1–33.7%) and MRSA (21.4%, 95% CI: 17.8–25.4%) were the predominant pathogens. Prevalence varied significantly by region (Asia 46.1% vs Europe 31.8%; P < 0.001) and by facility income setting (low- and middle-income countries 50.8% vs high-income countries 33.6%; P < 0.001). Independent predictors of colonization were prior antibiotic exposure within 90 days (aOR 3.42, 95% CI: 2.67–4.39), presence of indwelling devices (aOR 2.81, 95% CI: 2.18–3.62), recent hospitalisation (aOR 2.46, 95% CI: 1.94–3.12), functional dependency (Barthel ≤40; aOR 1.92, 95% CI: 1.51–2.44) and prolonged LTCF stay > 12 months (aOR 1.74, 95% CI: 1.38–2.19). Egger’s test showed no evidence of small-study effects (P = 0.143). Conclusions: Approximately two in five LTCF residents harbour an MDRO, with a disproportionately high burden in low- and middle-income settings. Antimicrobial stewardship, device-care bundles, and structured post-discharge screening should be prioritised as cornerstones of IPC in geriatric long-term care.

Background: Atrial fibrillation (AF) is the most prevalent persistent cardiac arrhythmia and is closely linked to a heightened risk of thromboembolic stroke. The left atrial appendage (LAA) is acknowledged as the main location for thrombus development in non-valvular AF. Nevertheless, traditional clinical risk assessment tools like the CHA₂DS₂-VASc score fail to fully consider anatomical differences in the LAA that could affect stroke risk. Objective: This study aimed to evaluate various left atrial appendage shapes (chicken wing, cactus, windsock, and cauliflower) concerning thromboembolic risk and to ascertain if non-chicken wing shapes are linked to greater thromboembolic risk than the chicken wing type. Methodology: This analytical cross-sectional study took place at the Department of Cardiology, Mayo Hospital Lahore, between January 2025 and January 2026. Two hundred patients with non-valvular atrial fibrillation were recruited via consecutive sampling. The morphology of the LAA was evaluated through transesophageal echocardiography (TEE) or cardiac computed tomography angiography (CCTA) and categorized into four types. Thromboembolic risk was assessed through the CHA₂DS₂-VASc score, detection of left atrial appendage thrombus, spontaneous echo contrast, and previous occurrences of ischemic stroke or transient ischemic attack. Data were examined with SPSS version 26, and statistical significance was assessed using the Chi-square test, ANOVA, and multivariate logistic regression analysis. Result: The predominant LAA shape was chicken wing (40%), followed by windsock (30%), cactus (18%), and cauliflower (12%). Morphologies other than chicken wings exhibited notably elevated rates of left atrial appendage thrombus (p < 0.001), spontaneous echo contrast, and previous stroke/TIA. Cauliflower shape exhibited the greatest thrombus occurrence (33%), next was cactus (22%), followed by windsock (15%), and chicken wing (8%). In the multivariate analysis, cauliflower (OR: 2.9) and cactus structure (OR: 2.1) were distinct predictors of thromboembolic incidents. Conclusion: The morphology of the left atrial appendage is greatly linked to thromboembolic risk in individuals with atrial.

Interface dermatitis is a common yet aetiologically heterogeneous reaction pattern in routine dermatopathology. This was a retrospective case series of eight histopathologically confirmed cases diagnosed between 2025 and 2026 at a tertiary care centre in Kerala with notable clinical and microscopic variation. Three presented with a lichenoid interface pattern (lichen planus, lichen planus pigmentosus, lichenoid drug eruption); three had vacuolar changes (discoid lupus erythematosus, dermatomyositis and fixed drug eruption); and two showed mixed patterns (erythema multiforme and pityriasis lichenoides et varioliformis acuta). In our study, drug triggers were confirmed in four cases; notably, one was associated with Sjögren syndrome and erythema multiforme, illustrating the diversity of autoimmune and iatrogenic causes. Histological overlap in these cases creates diagnostic hurdles, particularly where advanced testing is unavailable. This series highlights the value of meticulous clinicopathological correlation, targeted special stains, and thorough medication histories to ensure accurate diagnosis and optimal patient management in routine practice.

Introduction: Head and neck squamous cell carcinoma (HNSCC) represents a major oncological burden in Eastern India. Concurrent chemoradiotherapy (CCRT) with cisplatin is the standard of care for locally advanced HNSCC, but it is associated with severe toxicities. Malnutrition is highly prevalent in these patients and may exacerbate treatment toxicities, leading to poor compliance. This study aimed to evaluate the impact of baseline nutritional status, assessed using the Patient-Generated Subjective Global Assessment (PG-SGA), on treatment-related toxicities and therapeutic compliance in HNSCC patients undergoing CCRT. Methods A prospective observational study was conducted at a regional cancer center in Cuttack, India, involving 160 adult patients with stage III–IV locally advanced HNSCC undergoing definitive CCRT. Baseline nutritional status was classified into SGA-A (well-nourished), SGA-B (moderately malnourished), and SGA-C (severely malnourished). Treatment toxicities were graded using the Common Terminology Criteria for Adverse Events (CTCAE v5.0). Compliance was measured by chemotherapy dose reductions (>= 25%), radiotherapy interruptions (> 7 days), and emergency hospitalizations. Results Of the 160 enrolled patients, 30.0% (n = 48) were well-nourished (SGA-A), 45.0% (n = 72) were moderately malnourished (SGA-B), and 25.0% (n = 40) were severely malnourished (SGA-C), yielding a baseline malnutrition prevalence of 70.0%. Malnourished patients (SGA-B/C) experienced significantly higher rates of severe (Grade >= 3) oral mucositis (39.3% vs. 16.7%; p = 0.004), Grade >= 3 radiation dermatitis (28.6% vs. 12.5%; p = 0.03), and weight loss >= 10% during treatment (51.8% vs. 10.4%; p < 0.001) compared to well-nourished patients. Malnutrition was also strongly associated with treatment non-compliance, including radiotherapy interruptions > 7 days (33.9% vs. 10.4%; p = 0.002), chemotherapy dose reductions (26.8% vs. 8.3%; p = 0.01), and toxicity-related hospitalizations (30.4% vs. 12.5%; p = 0.02). Multivariable logistic regression identified malnutrition (SGA-B/C) as a powerful independent predictor of severe overall toxicity (adjusted OR: 3.84; 95% CI: 1.72–8.56; p = 0.001). A strong positive correlation was observed between percentage weight loss during treatment and total treatment interruptions (r = 0.64; p < 0.001). Conclusion Baseline malnutrition is highly prevalent in HNSCC patients in Odisha and serves as an independent predictor of severe chemoradiotherapy-induced toxicities and treatment interruptions. Early nutritional assessment using the PG-SGA, combined with proactive enteral support, is essential to minimize toxicities and preserve relative dose intensity in resource-constrained oncology frameworks.