Introduction: Traditional metrics like radiological alignment and surgeon-assessed range of motion often fail to capture a patient’s true recovery experience following total knee arthroplasty (TKA). Patient-reported outcome measures (PROMs) provide a vital, patient-centric perspective on surgical success. However, longitudinal data utilizing PROMs in Eastern India remains sparse. This study evaluates the trajectory and clinical significance of patient-reported recovery following primary TKA at a tertiary government hospital in this region.

Methods: We conducted a prospective longitudinal observational cohort study tracking 73 patients who underwent primary unilateral TKA for primary knee osteoarthritis over 12 months. Patients were evaluated using four validated instruments: the Visual Analogue Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), and Short Form-36 (SF-36). Assessments occurred pre-operatively and at 1, 3, 6, and 12 months post-surgery. We analyzed score trends, examined outcome predictors using binary logistic regression, evaluated inter-PROM relationships, and calculated the achievement of the minimal clinically important difference (MCID) for each metric. Results: The cohort (mean age 62.8 ± 4.3 years; 67.1% female) demonstrated highly significant improvements across all four PROMs during the follow-up period (p < 0.001 for all). The most dramatic recoveries occurred within the first three months, with continued stabilization up to one year. By 12 months, mean VAS dropped from 7.4 to 1.0, WOMAC improved from 63.7 to 22.0, OKS rose from 19.8 to 35.5, and SF-36 increased from 37.7 to 71.6. MCID thresholds were met by 100% of patients for VAS, 94.5% for WOMAC, 93.2% for SF-36, and 84.9% for OKS. While increasing age, prolonged symptom duration, and early complications showed a trend toward poorer outcomes, they did not reach independent statistical significance. Furthermore, baseline body mass index (BMI), deformity pattern, and Kellgren-Lawrence radiological severity did not meaningfully impact PROM improvements. Inter-instrument correlations at 12 months were notably strong. Conclusions: Total knee arthroplasty delivers robust, clinically meaningful improvements in pain, functional mobility, and overall quality of life for patients in Eastern India. Our findings closely align with international registry data, underscoring that radiological severity does not dictate recovery quality. These results strongly advocate for the routine integration of PROMs alongside standard clinical assessments in regional orthopaedic practice to truly measure surgical success from the patient's perspective.

Objective: To compare the clinical and radiographic outcomes of dental implants subjected to early loading and delayed loading. Methods: A multicenter comparative study was conducted from 18 June 2025 to 18 June 2026. A total of 47 patients receiving 61 dental implants were included. Patients were assessed according to early or delayed prosthetic loading. Clinical outcomes included implant survival and implant related complications. Radiographic assessment was performed through evaluation of marginal bone level changes. Statistical comparisons were performed between the two loading groups. Results: Twenty-four patients received early loading and 23 patients received delayed loading. Implant survival was 95.8% in the early loading group and 95.7% in the delayed loading group. Mean marginal bone loss was 0.62 ± 0.24 mm with early loading and 0.71 ± 0.27 mm with delayed loading. The difference in marginal bone loss was not statistically significant. Peri implant inflammation was observed in 12.5% and 8.7% of patients respectively. Prosthetic complications occurred in 8.3% and 13.0% respectively. No significant difference was identified for the principal clinical or radiographic outcomes. Conclusion: Early loading demonstrated clinical and radiographic outcomes comparable with delayed loading. Favorable implant survival and limited marginal bone changes were observed with both protocols.

Background: Obesity may affect knee osteoarthritis (KOA) in a few ways: mechanical loading and metabolic-inflammatory pathways. This study compared metabolic, inflammatory, and adipokine profiles between obese and non-obese patients with KOA. Methods: This is an analytical cross-sectional study conducted at the Independent Medical College between 1^st November 2025 and 30^th April 2026. A consecutive sampling process was used to enroll 36 patients with primary KOA, comprising 18 obese and 18 non-obese patients. Demographic, clinical, anthropometric, metabolic, inflammatory, and adipokine parameters were examined. WOMAC and Kellgren-Lawrence grading were used to evaluate disease severity. SPSS version 26 was used for data analysis. Independent-samples t-test, Mann-Whitney U test, chi-square/Fisher's exact test, correlation analysis, and multivariable linear regression were applied. Results: Obese patients had significantly higher BMI, waist circumference, WOMAC scores, and advanced radiographic grades. They also had higher fasting glucose, HbA1c, triglycerides, LDL-C, insulin, HOMA-IR, hs-CRP, IL-6, TNF-α, leptin, and resistin, while HDL-C and adiponectin were significantly lower. BMI positively correlated with HOMA-IR, hs-CRP, leptin, WOMAC score, and Kellgren-Lawrence grade. Obesity remained independently associated with higher hs-CRP, HOMA-IR, leptin, and WOMAC scores and lower adiponectin. Conclusion: KOA patients with obesity had metabolic dysfunction, inflammatory activation, imbalance in adipokines, and higher disease severity level. These findings support an obesity-associated metabolic-inflammatory phenotype of KOA.

Background: Anemia is one of the commonest health problem and it is caused due to various nutritional, chronic disease and blood loss related factors. So, this study was undertaken to assess the pattern of etiology, risk factors and severity of anemia among patients admitted to district hospital, Palakkad Kerala. Methods: A hospital based cross-sectional study was carried out among 384 patients of age >13 years with Hb. <11gm/dL admitted in the Department of General Medicine, District Hospital, Palakkad from May 2021 to April 2022. Data of demographic, clinical and laboratory investigations were collected and the etiology and severity of anemia were assessed. Results: The mean age of study population was 61.8±16.4 years and 68.2% were females. Iron deficiency anemia was the commonest etiology (63.8%) followed by anemia of chronic disease (13.3%) and B12 deficiency (12.0%). About 14% had anemia due to blood loss. Microcytic anemia was the commonest morphological pattern. The mean Hb was 6.37±1.94 g/dL and 68.8% patients had severe anemia. Increasing age was Really connected to severity of anemia (p=0.008). Vegetarianism, alcohol intake, walking barefoot and poor hygiene were quite a bit connected to severity. Conclusion: Iron deficiency was a major etiology in anemia and patients are seen to be presenting severely ill. The data highlight the importance of screening at an early stage, nutritional evaluation, detection of any underlying chronic illnesses and ongoing blood loss as well as early etiological treatment to minimize the severity.

Objective: To compare cardiovascular outcomes and renal safety of intravascular imaging-guided versus angiography-guided percutaneous coronary intervention (PCI) in acute coronary syndromes (ACS). Study Design: Systematic review with aggregate-data meta-analysis of randomized controlled trials and separately extractable randomized ACS subgroups. Place and Duration of Study: Global published evidence searched through 6 October 2026. Methodology: A reproducible PubMed search and targeted citation retrieval identified ACS-specific trial evidence. Compatible target-vessel failure (TVF) hazard ratios were pooled using inverse-variance random-effects analysis. Broader composite outcomes and differently defined kidney-injury events were examined separately. Conservative modified Hartung–Knapp intervals tested small-study uncertainty.

Results: Ten trial cohorts comprised 7,229 randomized ACS participants. Two compatible TVF cohorts included 4,337 participants: pooled HR 0.61 (95% CI 0.46–0.80; p=0.00046; I²=17.8%). The conservative interval was 0.10–3.67. Adding the broader OCCUPI ACS composite gave HR 0.59 (95% CI 0.47–0.73; I²=0%). Exploratory pooling of two differently defined renal endpoints in 1,072 participants gave RR 0.80 (95% CI 0.35–1.87; p=0.611). Conclusion: Imaging guidance supported lower cardiovascular event risk in selected ACS patients. Renal benefit remained uncertain. Sparse compatible trials and subgroup evidence require cautious interpretation.

Introduction: E-cadherin is a calcium dependent adhesion molecule required to maintain epithelial integrity. This impaired has been attributed to its loss and some cell cohesion was disrupted and it also led to an increase. tumor invasiveness. This paper set out to assess E-cadherin expression of the urothelial carcinoma and their dependence upon tumor grade and penetrating depth.  Methodology: It consisted of a cross-sectional study carried at the department of pathology, Pakistan Institute of Medical Sciences (PIMS), Islamabad, over a period of 24 months (August 2018 to August 2020). A total of 96 histologically confirmed cases of urothelial carcinoma were included using non-probability consecutive sampling. Immunohistochemistry was performed to assess E-cadherin expression, which was classified as preserved or reduced based on membranous staining in tumor cells. The Chi-square test was used to examine relationships between tumor grade and invasion into the muscularis propria and lamina propria. Results: E-cadherin expression was preserved in 53 cases (55.2%) and reduced in 43 cases (44.8%). Reduced expression was significantly more frequent in high-grade tumors (67.3%) compared to low-grade (18.2%) (p < 0.001). Tumors with muscularis propria invasion also showed significantly more reduced E-cadherin expression (72.7%) than those without (30.2%) (p < 0.001). Lamina propria invasion was similarly associated with reduced expression (p = 0.041). Conclusion:  Reduced E-cadherin expression correlates significantly with higher tumor grade and depth of invasion, highlighting its use as a prognostic marker in urothelial carcinoma. 

Introduction: Achieving sustained glycemic control in type 2 diabetes mellitus while maintaining acceptable tolerability is an important therapeutic goal. Vildagliptin, a dipeptidyl peptidase-4 inhibitor, augments endogenous incretin activity in a glucose-dependent manner, whereas metformin mainly lowers hepatic glucose output. This study evaluated and compared the efficacy and safety of these two agents when used as monotherapy in adults with newly diagnosed type 2 diabetes mellitus. Methods: A prospective randomized controlled study was carried out in the General Medicine outpatient department of Sri Venkateswara Ram Narayan Ruia Government General Hospital, Tirupati, between December 2023 and August 2024. Sixty adults aged 30–60 years with newly diagnosed type 2 diabetes mellitus were assigned in equal numbers to receive either vildagliptin 50 mg once daily or metformin 500 mg once daily. Fasting blood glucose, two-hour postprandial blood glucose, and HbA1c were measured at baseline, 3 months, and 6 months. Paired t-tests were used for within-group comparisons were reported, and independent-samples t-tests were used for comparisons between groups. Adverse events were documented during follow-up. Results: Both treatment groups demonstrated improvement in the measured glycemic parameters. At 6 months, mean fasting blood glucose was 118.83 ± 14.86 mg/dL in the vildagliptin group and 124.20 ± 28.75 mg/dL in the metformin group (between-group p=0.367). Mean postprandial glucose fell from 269.00 ± 90.23 to 167.53 ± 17.29 mg/dL with vildagliptin and from 294.93 ± 100.08 to 201.73 ± 45.46 mg/dL with metformin. The 6-month between-group difference in postprandial glucose was −34.20 mg/dL (95% CI −51.97 to −16.43; p=0.0003), recalculated from the reported summary statistics. HbA1c declined from 8.04 ± 0.65% to 7.03 ± 0.40% with vildagliptin and from 7.88 ± 0.81% to 7.57 ± 0.66% with metformin; the corresponding 6-month between-group difference was −0.54 percentage points (95% CI −0.82 to −0.26; p=0.0003), also recalculated from the reported summary statistics. No hypoglycemic events were observed. Allergy was reported in three participants in each group; headache occurred in four vildagliptin-treated participants and five metformin-treated participants; gastrointestinal intolerance was reported in four participants receiving vildagliptin and in none receiving metformin. Conclusion: In this small, single-center randomized study, both monotherapies were associated with improved glycemic indices. Vildagliptin showed a greater observed fall in HbA1c and a lower 6-month postprandial glucose value than metformin, while the difference in fasting glucose between groups was not statistically significant. These observations are specific to the present study population and regimen; confirmation in larger, multicenter randomized studies using participant-level analyses is required before broader conclusions are drawn.

Diabetes Mellitus is comprised of two categories: Type 1 Diabetes Mellitus (T1DM) and Type 2 Diabetes Mellitus (T2DM). It is one of the most frequently occurring non-communicable illnesses in the world today, with a global prevalence rate of 537 million people living with diabetes worldwide among the adult population. Traditional techniques used to treat diabetes mellitus cases have been rendered insufficient as far as ensuring personalized care that provides timely regulation of the blood sugar levels is concerned. The advancements in the field of artificial intelligence technologies have brought about revolutionary methods of managing diabetes, including diagnostics, treatment, and support. This systematic review followed the PRISMA guidelines for research, including articles obtained from PubMed, Web of Science, and Scopus databases up to April 2026. There were twenty-two articles that fulfilled the criteria for selection and quality. The application of artificial intelligence technology led to statistically significant improvements in HbA1c, TIR, early identification of micro- and macrovascular complications, personalized insulin therapy, and increased engagement and empowerment of patients. Highly sophisticated algorithms such as recurrent neural networks, transformers, gradient-boosted machine ensembles, and reinforcement learning agents were shown to be very effective in predicting hypoglycemia and risk stratification. The digital health interventions helped increase the compliance rate of patients with treatment regimens by 25-35%. Nevertheless, some issues were still present such as inequities in access to advanced technologies, a lack of multicentric and multi-ethnic validation, regulatory uncertainties, and immaturity with respect to data governance. Artificial intelligence is revolutionizing diabetes care with an emphasis on prediction, prevention, personalization, and participation.

Introduction: Variant RARA rearrangements in acute promyelocytic leukemia (APL) are rare and may present with atypical morphologic and immunophenotypic features, leading to diagnostic challenges. We report a case of a 9-year-old female child presenting with clinical and morphologic features suggestive of acute myeloid leukemia (AML) with monocytic differentiation. Flow cytometry supported a diagnosis of acute myelomonocytic leukemia. However, conventional cytogenetic analysis revealed a variant t(11;17)(q23;q21) translocation involving the RARA gene. This case underscores the importance of integrated morphologic, immunophenotypic, and cytogenetic evaluation for accurate classification and therapeutic stratification.