Student's Journal of Health Research Africa
Student's Journal of Health Research Africa (SJHR-Africa) is an international, peer-reviewed, open-access scholarly journal committed to advancing high-quality research that improves health outcomes in Africa and beyond. The journal provides an inclusive platform for the dissemination of original research, systematic reviews, case reports, short communications, and evidence-based scholarly work across the health sciences and related disciplines. SJHR-Africa is indexed in the Directory of Open Access Journals (DOAJ) and has been selected for inclusion in the Elsevier EMBASE database, reflecting its commitment to international publishing standards, rigorous peer review, and scientific quality. The journal is published in both online (ISSN: 2709-9997) and print (ISSN: 3006-1059) editions, ensuring broad accessibility and global visibility of published research. While the journal places particular emphasis on supporting student researchers, early-career scientists, and emerging scholars, it welcomes high-quality submissions from researchers, academics, clinicians, and professionals worldwide. SJHR-Africa is dedicated to promoting equitable access to scientific knowledge by making all published articles freely available to readers without subscription barriers, thereby fostering innovation, collaboration, and evidence-informed decision-making in healthcare.
Physical health changes associated with COVID-19-related school closure among schoolchildren: A descriptive cross-sectional study
Background COVID-19-related school closures disrupted structured physical activity, dietary routines, outdoor play, and school-based health surveillance while substantially increasing dependence on digital learning. Indian school data evaluating concurrent changes in screen exposure, body mass index (BMI), dietary behaviour, physical activity, and clinical nutritional findings remain limited. Objectives: To assess physical-health changes associated with COVID-19-related school closure among children aged 6-12 years, focusing on BMI, screen time, physical activity, dietary habits, clinical pallor suggestive of anaemia, and visible signs suggestive of vitamin deficiency. Methods This descriptive cross-sectional study, with retrospective comparison of pre-lockdown school health records, was conducted from June 2022 to April 2023 in three schools in Hyderabad, India. Children with accessible pre-lockdown anthropometric records were enrolled by convenience sampling after written parental consent. Current anthropometry and clinical findings were recorded, and parents reported changes in diet, activity, and screen exposure. Results A total of 640 children were analysed; the mean age was 9.02 ± 1.69 years, and 373 (58.3%) were boys. Meal frequency increased in 389 (60.8%), and all parents perceived reduced physical activity. Mean total screen time increased from 1.89 ± 0.98 to 10.60 ± 2.40 hours/day (reported p<0.0001). Mean BMI increased from 15.45 ± 1.41 to 18.02 ± 2.44 kg/m² (reported p<0.0001). Overweight or obesity increased from 56 (8.75%) before lockdown to 117 (18.28%) at assessment. Clinical pallor was present in 198 (30.9%); no visible signs suggestive of vitamin deficiency were documented. Conclusion The school-closure period was associated with pronounced increases in sedentary behaviour, screen time, meal frequency, and excess-weight prevalence. Recommendations School-health recovery programmes should restore structured physical activity, provide age-appropriate screen-use counselling, strengthen nutritional assessment, and arrange haemoglobin testing for children with pallor.
Copyright (c) 2026 Dr N. Santosh Kumar, Dr Machiraju Vasudeva Murali, Dr. Baswaraj T https://creativecommons.org/licenses/by-nc-nd/4.0
Reciprocal accessory tendons of the extensor carpi radialis longus and brevis with an interlacing pattern: A cadaveric cross-sectional observational study.
Background Anatomical variations of the radial wrist extensors include accessory muscle bellies, supernumerary tendons, intertendinous connections, and anomalous distal attachments. A configuration in which accessory tendons arise from both the extensor carpi radialis longus (ECRL) and extensor carpi radialis brevis (ECRB), interlace, and continue distally beside the opposite primary tendon is uncommon. Objectives: To document the gross morphology, frequency within the dissected sample, and potential clinical relevance of reciprocal accessory ECRL and ECRB tendons identified during routine cadaveric dissection. Methods This descriptive cross-sectional cadaveric study examined 20 formalin-embalmed upper limbs in the Department of Anatomy. A standardized dissection sequence exposed the lateral forearm and second dorsal extensor compartment. The origin, course, crossing relationship, and distal continuation of the primary and accessory tendons were recorded and photographed. All available limbs were assessed to reduce selective inclusion, and findings were summarized using counts, percentages, and structured morphological descriptors. Results One of the 20 upper limbs (5.0%) showed simultaneous accessory tendons of the ECRL and ECRB. The accessory ECRL tendon coursed medially toward the ECRB, whereas the accessory ECRB tendon crossed superficially through the ECRL region. The slips interlaced. Distally, the accessory ECRL tendon continued alongside the primary ECRB tendon, while the accessory ECRB tendon continued alongside the primary ECRL tendon. The remaining 19 limbs (95.0%) did not show this reciprocal configuration. Conclusion The observed arrangement expands the documented spectrum of radial wrist extensor anatomy. Recognition of reciprocal accessory tendons is relevant during dorsal wrist ultrasonography, magnetic resonance imaging, tendon harvesting, reconstructive tendon transfer, and operative exposure of the second extensor compartment. Recommendations Surgeons and radiologists should trace unexpected radial wrist extensor slips carefully to avoid misidentification and inadvertent injury during clinical procedures.
Copyright (c) 2026 Dr D Srivani, Dr T Pranathi, Dr N Kavya, Dr Prathiba K, Dr GN Charitha https://creativecommons.org/licenses/by-nc-nd/4.0
The Role of Interval Appendicectomy Following Conservative Management of Appendicular Mass and Appendicular Abscess: A Prospective Observational Study from a Tertiary Care Centre in Odisha, India
Background Conservative management using the Ochsner–Sherren regimen is widely accepted for appendicular mass and appendicular abscess. However, the routine role of interval appendicectomy after successful non-operative treatment remains controversial because of concerns regarding recurrence, operative morbidity, and occult appendiceal neoplasia. Objective To evaluate the clinical outcomes of conservative management and determine the role of interval appendicectomy in adults presenting with appendicular mass or appendicular abscess at a tertiary care teaching hospital. Methods A hospital-based prospective observational cohort study was conducted among 50 consecutive adult patients with clinically and radiologically confirmed appendicular mass or appendicular abscess who were managed initially with conservative treatment. Patients with abscesses underwent drainage when clinically indicated. Following successful resolution, participants were reassessed after 6–12 weeks and either underwent interval appendicectomy or continued active observation according to clinical judgement and patient preference. Results Conservative management was successful in all 50 participants. Twenty-eight (56.0%) had appendicular mass and 22 (44.0%) had appendicular abscess. Forty-two patients (84.0%) underwent interval appendicectomy, while eight (16.0%) remained under observation. Laparoscopic appendicectomy was successfully completed in 33 patients (78.6%), whereas seven (16.6%) required conversion to open surgery because of dense adhesions. Histopathological examination demonstrated findings consistent with resolved appendicitis. Conclusion Initial conservative management was safe and effective in this cohort. Interval appendicectomy was associated with low morbidity and favourable surgical outcomes. However, the short follow-up period and limited sample size support an individualized rather than routine approach to interval appendicectomy, particularly in younger patients.
Section of Anesthesia and Surgery Research
Copyright (c) 2026 Sourav Paikray, Ashoak Acharya, Dr. Asutosh Dhal, Durga Prasad Sahu https://creativecommons.org/licenses/by-nc-nd/4.0
Autograft versus Allograft in Anterior Cruciate Ligament Reconstruction: A Systematic Review and Meta-Analysis of Graft Failure, Knee Stability, and Functional Outcomes.
Background: Autograft and allograft are widely used for anterior cruciate ligament reconstruction (ACLR), but comparative outcomes vary with patient age, activity, graft processing, and outcome definition. Objective: To compare graft failure, knee stability, and functional outcomes after autograft versus allograft ACLR through 2025. Methods: PubMed/MEDLINE, Europe PMC, reference chaining, and established systematic reviews were searched for comparative primary ACLR studies. Adult nonirradiated-allograft studies were analysed separately from adolescent and young-patient cohorts. Random-effects RRs were calculated for adult binary outcomes and ORs for young-patient graft failure. Risk of bias and certainty were evaluated using domain-based criteria and GRADE. Results: Fifteen comparative reports contributed to quantitative synthesis. In mature patients receiving nonirradiated allografts, no clear differences were found for clinical graft failure (6 studies; 449 participants; RR 0.75, 95% CI 0.25–2.24; I²=0%), instrumented laxity failure (8 studies; 801 participants; RR 0.89, 95% CI 0.50–1.59; I²=0%), positive Lachman testing (5 studies; 527 participants; RR 1.11, 95% CI 0.79–1.57), or positive pivot shift (6 studies; 629 participants; RR 1.06, 95% CI 0.66–1.70). In adolescents and young patients, allograft was associated with greater graft-failure odds (6 studies; 854 participants; OR 3.82, 95% CI 2.32–6.31; I²=0%). Functional scores were generally similar, but incomplete dispersion data prevented robust pooling. Conclusion: Nonirradiated allografts can provide similar stability and function in selected skeletally mature, lower-risk patients, whereas autograft remains preferable for adolescents and highly active young patients because of lower observed failure. Evidence certainty was low. Future multicentre studies should stratify by age, skeletal maturity, activity, and allograft processing, and use standardised failure definitions with complete time-to-event reporting.
Copyright (c) 2026 Dr. Sachin N C, Dr. Tejal.VV, Dr. Vedavathi H https://creativecommons.org/licenses/by-nc-nd/4.0
Intramedullary Nailing versus Sliding Hip Screw Fixation for Intertrochanteric Femoral Fractures: A Systematic Review and Meta-Analysis of Clinical and Radiological Outcomes
Background: Intertrochanteric femoral fractures are commonly fixed with a cephalomedullary intramedullary nail (IMN) or a sliding hip screw (SHS). Implant use has shifted toward IMN despite persistent uncertainty regarding patient-important benefit, particularly for stable fracture patterns. Objective: To update randomized evidence comparing IMN and SHS fixation and to synthesize clinical, functional, and radiological outcomes reported in high-quality reviews published through 2025. Methods: A focused systematic update used the 21-randomized-trial corpus reported by Shin and colleagues as the anchor evidence set. Targeted PubMed/MEDLINE, Cochrane, trial-registry, with eligible publications restricted to 31 December 2025. A subsequent multicentre randomized trial was added. Revision or surgical failure was pooled as an odds ratio (OR) using inverse-variance methods. Secondary outcomes were synthesized from the contemporary trial and high-quality systematic reviews. Risk of bias, heterogeneity, small-study effects, and certainty were considered outcome specifically. Results: Twenty-two randomized trials contributed 4,431 participants to the revision/surgical-failure analysis. Events occurred in 100 of 2,204 SHS-treated and 93 of 2,227 IMN-treated participants. The pooled estimate did not demonstrate a clear difference (OR 1.14, 95% CI 0.84-1.54; I²=0%; P=0.401). The 2023 INSITE trial found no clinically meaningful 1-year EQ-5D difference (mean difference 0.02, 95% CI -0.03 to 0.07), no significant revision difference, and no interaction by fracture stability. Broader evidence showed little difference in mortality, return to theatre, or quality of life; older nail designs were associated with more implant-related femoral fractures. Small pooled differences in mobility scores favouring IMN were of uncertain clinical importance. Conclusion: For stable or reducible AO/OTA 31-A1 and selected 31-A2 fractures, SHS remains an evidence-supported, lower-cost option, while IMN does not provide a consistent patient-important advantage. For unstable A2, reverse-obliquity, or subtrochanteric-extension patterns, fracture mechanics and current guidelines favour cephalomedullary fixation, although direct comparative certainty for several outcomes remains limited.
Copyright (c) 2026 Dr Sachin N C, Dr. Tejal.VV, Dr. Vedavathi H https://creativecommons.org/licenses/by-nc-nd/4.0
Early versus Delayed Weight-Bearing after Surgical Fixation of Ankle Fractures: A Systematic Review and Meta-Analysis.
Background: Prolonged non-weight-bearing after ankle fracture fixation may protect reduction and implants but can delay mobility, increase stiffness, and prolong absence from work. Recent pragmatic trials have questioned the routine six-week restriction. Objective: To compare early and delayed weight-bearing after ankle fracture fixation regarding functional recovery, return to activity, mechanical failure, reoperation, and complications. Methods: This updated systematic review included reports through 31 December 2025. Adults commencing weight-bearing within three postoperative weeks were compared with those starting at four weeks or later. Evidence from randomised-trial meta-analyses was integrated with the 2024 WAX trial, 2025 INWN trial, and a 2025 syndesmotic-injury cohort. Risk of bias and certainty were assessed using RoB 2, ROBINS-I, and GRADE principles. Results: A 2025 meta-analysis of 10 randomised trials involving 1,276 participants showed improved Olerud-Molander Ankle Score with early weight-bearing at six weeks (mean difference [MD] 5.86, 95% confidence interval [CI] 3.64–8.08) and at 12 weeks to four months (MD 3.17, 95% CI 0.84–5.50), but not at 12 months (MD 1.86, 95% CI −0.50–4.22). Return to work or daily activities occurred 1.75 weeks earlier (95% CI 0.98–2.52). Overall complications were not significantly different (risk ratio 1.34, 95% CI 0.96–1.86). The INWN trial reported a 10.4-point adjusted six-week OMAS benefit with immediate protected weight-bearing and favourable cost-utility. A syndesmotic-injury cohort reported earlier recovery without fixation loss. Conclusions: Early protected weight-bearing after stable ankle fracture fixation provides modest short-term functional improvement and earlier return to activity, although benefits diminish over time. Evidence does not show a clear increase in complications, but safety remains uncertain in high-risk cases. Protocols should be individualised according to fixation stability, soft-tissue status, comorbidity, protective sensation, and adherence.
Copyright (c) 2026 Dr .Sachin N C, Dr. Tejal.VV, Dr. Vedavathi H https://creativecommons.org/licenses/by-nc-nd/4.0
Arthroscopic versus Open Repair for Rotator Cuff Tears: A Systematic Review and Meta-Analysis of Functional Outcomes, Retear Rates, and Complications
Background: Rotator cuff repair is increasingly performed arthroscopically, but its comparative advantages over conventional open and mini-open repair remain uncertain. Objective: To compare functional outcomes, structural retear, pain, range of motion, and complications after arthroscopic versus open or mini-open rotator cuff repair. Methods: MEDLINE/PubMed, the Cochrane Library, trial registries, reference lists, and citation searches were searched from inception through 31 December 2025. Randomised and non-randomised comparative studies of adults undergoing primary repair were eligible. Conventional open and mini-open procedures were analysed separately. To avoid double-counting, the most complete outcome-specific pooled estimates from overlapping evidence syntheses were retained. Risk of bias and certainty were evaluated using RoB 2 or ROBINS-I domains and GRADE principles. Results: Thirty-three comparative studies were identified: six randomised trials and 27 cohorts. Long-term function was generally comparable. Pooled estimates showed no important difference in ASES score (SMD 0.14, 95% CI -0.07 to 0.34; I²=0%) or DASH score (SMD -0.01, 95% CI -0.28 to 0.25; I²=0%). A reported Constant-Murley advantage for mini-open repair (SMD 0.87, 95% CI 0.11 to 1.62) was heterogeneous (I²=81%). Pain differences through 12 months were below clinical-importance thresholds. A retear advantage for mini-open repair (odds ratio 0.48, 95% CI 0.25 to 0.92; I²=0%) disappeared in double-row comparisons. Arthroscopy yielded faster early pain and motion recovery, whereas infection, stiffness, revision, and long-term healing were similar. Conclusion: Arthroscopic and open or mini-open repair provide broadly comparable medium- and long-term outcomes. Arthroscopy may accelerate early recovery, but clinically meaningful long-term superiority is unproven. Technique selection should consider tear morphology, tissue quality, fixation, surgeon expertise, and resources.
Comparative Outcomes of Locking Plate Fixation versus Intramedullary Nailing in Distal Femur Fractures: A Systematic Review and Meta-Analysis
Background: Locking plate fixation and retrograde intramedullary nailing are established treatments for distal femur fractures, but implant selection remains influenced by fracture morphology, bone quality and surgeon preference. Evidence published after the search cut-off of a major 2022 review required a transparent update through November 2025. Objective: To synthesise comparative studies published after the search cut-off of a major 2022 review and to estimate contemporary effects for nonunion, while summarising infection, fracture healing and functional outcomes. Methods: A sequential update strategy was used. PubMed/MEDLINE, PubMed Central, publisher repositories and citation links were searched for comparative adult studies published from 26 February 2022 to 30 November 2025. Randomised and non-randomised studies directly comparing retrograde intramedullary nailing with locking plate fixation were eligible. Risk ratios (RRs) were pooled using inverse-variance random-effects models with a modified Hartung-Knapp confidence interval when at least three compatible studies were available. Heterogeneity was assessed with I² and τ². Risk of bias was appraised using RoB 2 or ROBINS-I principles, and certainty was judged with GRADE. Results: Three retrospective comparative studies enrolled 345 patients. All three studies contributed nonunion data. Nonunion occurred in 17 of 173 patients treated with nailing and 29 of 172 treated with plating; the pooled estimate favoured nailing but remained statistically uncertain (RR 0.54, 95% CI 0.17–1.69; p=0.145; I²=0%). Two studies involving 152 participants reported postoperative infection, with 2 events among 80 nailing patients and 4 among 72 plating patients; the evidence was too sparse for pooling. Healing time was numerically shorter after nailing in all three studies, whereas functional findings were inconsistent. Conclusion: Comparative evidence available through November 2025 does not establish universal superiority of either implant. Nailing may reduce nonunion and accelerate healing, but the estimate remains imprecise, while infection and functional data are insufficient for a dependable conclusion.
Copyright (c) 2026 Dr. Vedavathi H, Dr. Sachin N C, Dr. Tejal.VV https://creativecommons.org/licenses/by-nc-nd/4.0
Robotic-Assisted versus Conventional Total Knee Arthroplasty: A Systematic Review of Functional Outcomes and Complications
Background: Robotic-assisted total knee arthroplasty (RA-TKA) improves the reproducibility of bone resection, component positioning, and limb alignment, but its effect on patient-important outcomes remains debated. This review evaluates evidence available through November 2025 comparing RA-TKA with conventional total knee arthroplasty (C-TKA), with emphasis on validated functional outcomes, perioperative measures, and complications. Methods: A structured evidence update was performed through 30 November 2025. Systematic reviews and meta-analyses of randomized controlled trials published between 2023 and 2025, together with randomized studies available by the cutoff date, were prioritized. Outcomes included Oxford Knee Score (OKS), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Forgotten Joint Score (FJS), range of motion (ROM), pain, adverse events, operative time, blood loss, and radiographic alignment. Published pooled estimates were synthesized without re-pooling overlapping datasets. Results: Randomized-trial meta-analyses consistently demonstrated fewer alignment outliers and smaller deviation from the planned mechanical axis with RA-TKA. A 2025 meta-analysis of 21 randomized trials involving 2,692 patients reported fewer alignment outliers (risk ratio 0.33, 95% confidence interval [CI] 0.19–0.59), a smaller mechanical-axis deviation (mean difference [MD] −0.93 degrees, 95% CI −1.20 to −0.66), a small KSS advantage (MD 1.03, 95% CI 0.50–1.57), no meaningful ROM benefit, and an increase in operative time of approximately 20 minutes. Most pooled PROMs and complication outcomes were similar between groups. One 180-patient randomized trial reported better 12-month PROMs and pain outcomes with an imageless handheld system, but the platform-specific and industry-funded design limits generalizability. Conclusions: RA-TKA provides a consistent radiographic precision advantage, whereas evidence for a durable and clinically important functional benefit remains heterogeneous and platform-dependent. Long-term, independently funded trials using standardized PROMs, predefined alignment strategies, and economic evaluation are required.
SOX-2 Expression in Cervical Squamous Intraepithelial Neoplasia and Invasive Squamous Cell Carcinoma: An Immunohistochemical Study
Background: SOX-2 is a transcription factor that plays a key role in stem cell maintenance and pluripotency and has emerged as a potential marker of cancer stem cell activity in cervical carcinogenesis. However, its expression across the entire spectrum of cervical squamous intraepithelial lesions (SIL) and invasive squamous cell carcinoma (SCC) has not been fully characterised. This study evaluated the immunohistochemical (IHC) expression of SOX-2 in low-grade SIL (LSIL), high-grade SIL (HSIL), and invasive SCC of the uterine cervix and examined its association with histopathological grade and patient age. Methodology: This hospital-based cross-sectional observational study was carried out in the Department of Pathology in collaboration with the Department of Obstetrics and Gynaecology, B.R.D. Medical College, Gorakhpur, over a one year period (2024–2025). A total of 150 histopathologically confirmed formalin-fixed paraffin-embedded cervical biopsy specimens underwent IHC staining using a monoclonal anti-SOX2 antibody (clone SOX2/1791). Nuclear immunoreactivity was evaluated using a semi-quantitative histoscore (H-score), with scores ranging from 5 to 12 considered positive. Statistical analysis was performed using SPSS version 25.0. Categorical variables were analysed using the Chi-square test or Fisher's exact test, as appropriate, and a p-value < 0.05 was considered statistically significant. Results: SOX-2 positivity was observed in 115 of 150 cases (76.6%), increasing progressively from LSIL (16.7%) to HSIL (69.6%) and SCC (81.0%) (χ² = 26.91, p < 0.001). A significant association was also observed with advancing age (χ² = 27.28, p = 0.000017). No significant association was found between SOX-2 expression and tumour grade (p = 0.44) or histological subtype (p = 0.66) within SCC. Conclusions: SOX-2 expression rises progressively with increasing severity of cervical squamous lesions, supporting its role as a biomarker of cervical carcinogenesis and a potential adjunct IHC marker for risk stratification of premalignant and malignant cervical lesions.
Section of Obstetrics and Gynecology Research
Copyright (c) 2020 Dr. Priyamvada Maurya, Shaila Mitra, Sonal R. Goel, Ankita Kumari, Rajesh Kumar Rai https://creativecommons.org/licenses/by-nc-nd/4.0
Erythrocyte band 3 profile in falciparum malaria and sickle cell disease: a comparative cross-sectional study.
Background Band 3 is a major erythrocyte membrane protein involved in membrane structure, parasite invasion, cytoadherence, and sequestration. Alterations in Band 3 may contribute to the pathophysiology of falciparum malaria and sickle cell disease. This study evaluated the Band 3 profile in these conditions. Methods This single-center comparative cross-sectional study included patients with uncomplicated falciparum malaria, severe falciparum malaria, sickle cell disease, and healthy controls. Malaria was diagnosed by peripheral blood smear and/or rapid diagnostic testing, while sickle cell disease was confirmed by high-performance liquid chromatography. Erythrocyte membrane Band 3 was analyzed using sodium dodecyl sulfate-polyacrylamide gel electrophoresis and densitometry. Band 3 fragmentation was assessed as high-molecular-weight aggregates, Band 3 monomer, and proteolytic fragments. Results Among 71 participants, 19 had uncomplicated malaria, 22 had severe malaria, 20 had sickle cell disease, and 10 were healthy controls. Relative to controls, Band 3 densitometric values were 139% in uncomplicated malaria, 138% in severe malaria, and 171% in sickle cell disease. High-molecular-weight aggregates were increased in severe malaria and sickle cell disease, whereas proteolytic fragments were reduced. Band 3 density did not differ significantly between uncomplicated and severe malaria. Conclusion Falciparum malaria and sickle cell disease were associated with quantitative and structural alterations in erythrocyte Band 3. Recommendation Larger multicenter and longitudinal studies with molecular and functional investigations are recommended to validate these findings and determine the potential diagnostic and prognostic significance of Band 3 alterations.
Copyright (c) 2026 Ashima Mishra, Prafulla Kumar Bariha, Kshetramohan Tudu, Dukhia Murmu, Manoj Kumar Mohapatra https://creativecommons.org/licenses/by-nc-nd/4.0
Effectiveness of Bisphosphonates in Preventing Periprosthetic Bone Loss after Joint Replacement: A Systematic Review and Meta-Analysis
Background: Periprosthetic bone loss after joint replacement may compromise bone stock and contribute to implant migration, aseptic loosening, fracture, and technically difficult revision. Bisphosphonates suppress osteoclast-mediated resorption, but trial findings differ by joint, anatomical region, drug, and follow-up. Objective: To evaluate the effectiveness and safety of bisphosphonates for preventing periprosthetic bone loss after hip and knee joint replacement. Methods: An updated systematic evidence synthesis was undertaken using PubMed/MEDLINE, publisher full-text databases, and backward and forward citation tracking through 30 November 2025. Randomised comparative trials of a bisphosphonate versus placebo, no treatment, or calcium/vitamin D alone were eligible. The primary de novo meta-analysis combined 12-month total periprosthetic bone mineral density (BMD) change after total hip arthroplasty (THA) when outcomes were reported in g/cm². A restricted maximum-likelihood random-effects model with Hartung–Knapp confidence intervals was used. Anatomically incompatible hip and knee outcomes were retained as prespecified strata. Results: Twenty-five randomised trial reports involving 1,115 participants were represented across the verified hip, osteoporotic-hip/zoledronic-acid, and knee evidence sets. Ten THA trials (420 analysed participants) contributed to the de novo 12-month analysis. Bisphosphonates preserved total periprosthetic BMD by 0.063 g/cm² (95% CI 0.040–0.085; p<0.001; I²=51.3%; τ²=0.000238); the 95% prediction interval was 0.021–0.104 g/cm². Published random-effects strata also showed benefit at 2–4 years (MD 0.04 g/cm²) and beyond 5 years (MD 0.08 g/cm²) after THA. After total knee arthroplasty (TKA), proximal tibial BMD was higher at 3 and 6 months but not clearly at 12 months, while distal femoral estimates favoured alendronate but were highly heterogeneous. In osteoporotic hip-arthroplasty populations, zoledronic acid preserved BMD most consistently in Gruen zones 1, 6, and 7; influenza-like symptoms were more frequent (RR 7.03, 95% CI 2.63–18.78), without a demonstrated increase in serious adverse events.
Section of Pharmacology and Chemotherapeutics
Copyright (c) 2026 Dr. Vedavathi H, Dr Sachin N C, Dr. Tejal.VV https://creativecommons.org/licenses/by-nc-nd/4.0
Efficacy of Platelet-Rich Plasma versus Corticosteroid Injections in Knee Osteoarthritis: A Systematic Review and Meta-Analysis
Background: Intra-articular corticosteroids can provide rapid but short-lived symptom relief in knee osteoarthritis (OA), while platelet-rich plasma (PRP) may offer a more durable effect through biologic modulation. Aim: To compare the efficacy and safety of intra-articular PRP versus intra-articular corticosteroid injections in adults with knee OA. Methods: MEDLINE/PubMed, CENTRAL, and ClinicalTrials.gov were searched (last search: 9 January 2026) using prespecified, reproducible strategies. Comparative adult human clinical studies directly comparing PRP with intra-articular corticosteroid for knee OA were eligible. Primary outcomes were pain and function at prespecified windows (1–3 months, ~6 months, ~12 months). Random-effects meta-analysis (DerSimonian–Laird) pooled standardized mean differences (SMD; Hedges g). Risk of bias was assessed using RoB 2, and certainty of evidence was appraised with GRADE. Results: From 330 records (databases n=312; registers n=18), 234 records were screened after duplicate removal, and 18 full-text reports were assessed; 4 studies were included in the review. Three parallel-group randomized trials (total randomized n=154; analyzed n≈150 across outcomes) contributed continuous data to meta-analysis. At 1–3 months, PRP did not differ from corticosteroid for pain (SMD −0.15, 95% CI −0.59 to 0.30; I²=44%) or function (SMD 0.11, 95% CI −0.22 to 0.44; I²=0%). At ~6 months, PRP improved pain (SMD −0.79, 95% CI −1.38 to −0.19; I²=66%) and function (SMD 0.75, 95% CI 0.25 to 1.25; I²=52%) versus corticosteroid. At ~12 months (one trial), results favored PRP for both pain (SMD −1.27, 95% CI −1.99 to −0.55) and function (SMD 1.36, 95% CI 0.63 to 2.09). No serious adverse events were reported; one trial noted transient mild synovitis after PRP that resolved spontaneously. Conclusion: PRP and corticosteroid injections provide similar short-term outcomes (1–3 months). By ~6 months, PRP shows greater pain reduction and functional improvement, though heterogeneity and variable PRP protocols temper certainty. E
Role of cartridge-based nucleic acid amplification test in diagnosis of extrapulmonary tuberculosis; a cross-sectional study.
Background: Tuberculosis (TB) is an infectious disease caused by an acid fast bacilli known as Mycobacterium tuberculosis. It primarily affects the lungs (Pulmonary TB) but can also affect other organs (EPTB) like lymph nodes, pleura, CNS, meninges, bones and joints, kidney, spine, etc, which remains a major public health problem. Methodology: Patients with presumptive extrapulmonary TB, presenting complaints, Comorbidities, HIV status, and any past & contact history of tuberculosis were noted. Investigations like CPB, ESR, HIV, and RBS were done in all cases. For patients with suspected TB lymphadenopathy, FNAC was done, and pus was obtained and sent for CBNAAT & culture. Patients with pleural TB & Other EPTB samples, like pleural fluid, CSF, and ascitic fluid aspirated and sent for ADA proteins, cytology, and CBNAAT & culture. Results: Out of 100 extra-pulmonary cases, 55% were males and 45% were females. The most common age group was 21-40 years. The most common EPTB found was lymph node TB (45%), followed by TB pleural effusion (30%) and abdominal TB (10%). Sensitivity and Specificity of CBNAAT were 62.2% and 74.50%, respectively, in comparison with Culture. Out of the 100 samples, CBNAAT was Positive in 42 samples, culture was positive in 45, of which 9(21.42%) were Rifampicin-resistant. Conclusion: The diagnostic yield of CBNAAT was 42% in the EPTB samples. Therefore, the present study concludes that CBNAAT definitely plays a crucial role in the diagnosis of EPTB because of its simplicity and rapid turnaround time of 2 hrs & detects Rifampicin Resistance simultaneously for early initiation of MDR TB treatment compared to culture, as it takes a longer duration. Recommendation: CBNAAT is recommended as the initial test for suspected extrapulmonary tuberculosis, providing rapid detection of TB and rifampicin resistance.
Copyright (c) 2026 Dr. Divya Sree Lavudya, Dr. Naresh Mamidi, Dr. Sindhuja Vemula https://creativecommons.org/licenses/by-nc-nd/4.0
Benign Neural Tumors: A Cross-Sectional Study of Clinicopathological Characteristics.
Background Benign neural tumors comprise a heterogeneous group of neoplasms with diverse clinical and anatomical presentations. This study aimed to evaluate the demographic, histopathological, and anatomical distribution of benign neural tumors and assess the association between tumor type and anatomical location. Methods This hospital-based cross-sectional study was conducted at the Department of Pathology, IMS and SUM Hospital, Bhubaneswar, Odisha, India, over a two-year study period. A total of 86 histopathologically confirmed benign neural tumor cases were included. Demographic characteristics, tumor type, and anatomical location were recorded. Histopathological examination was performed using routine hematoxylin and eosin staining. The association between tumor type and anatomical location was assessed using the chi-square test, with p < 0.05 considered statistically significant. Results Among 86 cases, the largest proportion was aged 21–40 years (30, 34.9%). Schwannoma was the most common tumor (43, 50.0%), followed by neurofibroma (32, 37.2%) and granular cell tumor (11, 12.8%). The head and neck was the most frequent anatomical site (39, 45.3%), followed by extremities (28, 32.6%), spine (11, 12.8%), and intracranial sites (8, 9.3%). Among granular cell tumors, intracranial location had the highest frequency (4/11, 36.4%), while head and neck and spinal locations each accounted for 3/11 (27.3%). Tumor type was significantly associated with anatomical location (p = 0.04). Conclusion Benign neural tumors predominantly affected young to middle-aged individuals, with schwannoma being the most frequent tumor and the head and neck being the most common overall anatomical site. Histopathological evaluation remains essential for accurate diagnosis and classification. Recommendation Larger multicentre studies with standardized clinicopathological assessment and longer follow-up are recommended.
Section of Pathology, and Histopathology
Copyright (c) 2026 Dr. Prajna Paramita Samal, Dr. Subhashree Shantisudha, Dr .Subhashree Subhamita Dash https://creativecommons.org/licenses/by-nc-nd/4.0
Bacteriological profile and antimicrobial susceptibility patterns of diabetic foot ulcers: a prospective cross-sectional study.
Background Diabetic foot ulcers are a major source of infection-related morbidity, prolonged hospitalisation and lower-limb amputation. Their microbial spectrum varies across settings, while antimicrobial resistance increasingly limits empirical treatment. Objectives To characterise the bacteriological profile of clinically infected diabetic foot ulcers and determine the antimicrobial susceptibility patterns of recovered bacterial isolates in a tertiary-care hospital. Methods This prospective cross-sectional study included 71 adults with type 2 diabetes and clinically infected foot ulcers presenting from January to December 2024. Deep wound swabs, aspirated pus or tissue specimens were collected after wound preparation and processed by conventional culture and biochemical methods. Antimicrobial susceptibility was assessed by Kirby-Bauer disk diffusion using contemporaneous Clinical and Laboratory Standards Institute criteria. Multidrug resistance was defined as non-susceptibility to at least one agent in three or more antimicrobial categories. Results Significant bacterial growth was obtained from 62 of 71 specimens (87.3%). Staphylococcus aureus was the most frequent isolate (24.2%), followed by Escherichia coli (17.7%), Proteus species (16.1%) and Pseudomonas aeruginosa (12.9%). Polymicrobial infection occurred in 21.0% of culture-positive cases. Five of 15 S. aureus isolates (33.3%) were methicillin resistant. Resistance among E. coli was highest to amoxicillin-clavulanate (72.7%) and cotrimoxazole (54.5%), whereas meropenem and levofloxacin showed comparatively lower resistance (27.3% each). Overall, 19 isolates (30.6%) met the multidrug-resistance definition. Conclusion Clinically infected diabetic foot ulcers in this setting contained mixed bacterial flora with a substantial antimicrobial-resistance burden. Culture-directed therapy should accompany timely debridement, glycaemic optimisation and structured wound care. Recommendations Local antibiograms should be updated periodically, and empirical regimens should be reviewed promptly after culture results become available.
Copyright (c) 2026 Dr .Thannuri Fanindra, Dr .S Ruth Ramya, Dr. Aditi Tomer Thakur, Dr. Taruni, Dr. R Kondal Rao, Dr. Nagasaikaran Sade https://creativecommons.org/licenses/by-nc-nd/4.0
Early versus Late Tracheostomy under Sedation in Critical Care: A Single-Center Retrospective Cohort Study.
Background: The optimal timing of tracheostomy in critically ill patients requiring prolonged mechanical ventilation remains controversial. Early tracheostomy has been associated with improved clinical outcomes, but its impact on mortality remains uncertain. Objective: To compare the clinical outcomes of early (≤7 days) versus late (>7 days) tracheostomy under sedation in critically ill patients requiring prolonged mechanical ventilation. Methods: A single-center retrospective cohort study was conducted in the adult intensive care units of a tertiary care hospital in Gurgaon, India, from April 2024 to April 2025. A total of 140 patients were equally divided into early (n = 70) and late (n = 70) tracheostomy groups. Clinical characteristics, duration of mechanical ventilation, sedation duration, intensive care unit (ICU) and hospital stay, ventilator-associated pneumonia (VAP), mortality, and discharge outcomes were compared. Multivariable logistic regression was performed to identify predictors of in-hospital mortality. Results: Baseline characteristics were comparable between groups. Early tracheostomy significantly reduced the duration of mechanical ventilation (10.8 ± 4.2 vs. 15.6 ± 5.1 days), sedation (7.2 ± 3.1 vs. 11.4 ± 4.3 days), ICU stay (12.6 ± 5.3 vs. 18.1 ± 6.2 days), and hospital stay (18.9 ± 7.4 vs. 25.3 ± 8.6 days) (all p < 0.001). VAP occurred less frequently in the early group (17.1% vs. 34.3%; p = 0.02). ICU and in-hospital mortality did not differ significantly. APACHE II score independently predicted in-hospital mortality. Conclusion: Early tracheostomy was associated with improved clinical recovery and fewer complications but did not significantly reduce mortality. Recommendation: Early tracheostomy should be considered for appropriately selected patients expected to require prolonged mechanical ventilation. Larger prospective multicenter studies are needed to validate these findings.
Copyright (c) 2026 Subhash Chandra, Madhukant, Neha Chahar https://creativecommons.org/licenses/by-nc-nd/4.0
Fibrin Glue versus Sutures for Conjunctival Autograft Fixation in Primary Pterygium Surgery: A Systematic Review of Randomized Controlled Trials.
Background: Conjunctival autografting reduces recurrence after pterygium excision, but the graft-fixation technique may influence operative time, ocular comfort, graft stability, and postoperative complications. Objective: To systematically synthesize randomized evidence comparing fibrin glue with sutures for securing conjunctival or limbal-conjunctival autografts in primary pterygium surgery. Methods: This systematic review used a foundational evidence search of PubMed, Embase, Cochrane CENTRAL, Web of Science, and CINAHL conducted through 8 November 2024. An updated search covering 9 November 2024 to 12 July 2026 was performed in PubMed and ClinicalTrials.gov, supplemented by reference-list screening and forward-citation searching. Two reviewers independently screened records, assessed eligibility, and extracted data. Disagreements were resolved by consensus, with third-reviewer adjudication available. Randomized controlled trials comparing commercial or autologous fibrin preparations with absorbable or non-absorbable sutures after primary pterygium excision were eligible. Published random-effects estimates were retained because complete trial-level datasets were unavailable; therefore, no new meta-analysis was conducted. Results: The foundational search identified 878 records. After removing 488 duplicates, 390 records were screened, 53 full-text reports were assessed, and 20 randomized controlled trials were included. The updated search identified no additional eligible direct-comparison trials. Recurrence favored fibrin glue, with an odds ratio for sutures versus glue of 2.46 (95% confidence interval, 1.06–5.69; P=0.035; I²=0%). Operative time was 15.65 minutes shorter with glue, and postoperative day 1 pain was lower. Considerable heterogeneity was observed for operative time and pain outcomes. Subconjunctival hemorrhage was reported in both groups, but inconsistent definitions and assessment periods prevented quantitative synthesis. Conclusion: This systematic review indicates that fibrin glue may reduce recurrence, shorten surgery, and improve early postoperative comfort compared with sutures. However, heterogeneity and inconsistent reporting limit certainty regarding the magnitude of benefit and complication risks.
Copyright (c) 2026 Dr. Sweety Kumari, Dr. Amith Kumar Pampalkar, Dr. Marru Pradeep https://creativecommons.org/licenses/by-nc-nd/4.0
Effect of Self-Paced Learning on Learning Outcomes of Phase II Undergraduate Medical Students: A Quasi-Experimental Study.
Background: Self-paced learning (SPL) is a learner-centered educational approach that promotes independent learning and lifelong learning, key objectives of competency-based medical education (CBME). However, evidence regarding its effectiveness among undergraduate medical students remains limited. Methods: A quasi-experimental study was conducted among 97 Phase II MBBS students in the Department of Microbiology. Students completed a 10-day SPL module on gastrointestinal and hepatobiliary infections using predefined learning objectives. Learning outcomes were assessed using 35 case-based multiple-choice questions (MCQs), while knowledge retention was evaluated one month later using a surprise 50-item MCQ assessment. Student perceptions were assessed using a 10-item five-point Likert questionnaire, and Satisfaction Index (SI) scores were calculated. Results: Of the 97 participants, 60 (61.9%) were male, and 37 (38.1%) were female. In the formative assessment, 59 (60.8%) students scored >75%, 37 (38.1%) scored 50–75%, and 1 (1.0%) scored <50%. Among the 75 students who completed the retention assessment, 15 (20.0%) scored >75%, 40 (53.3%) scored 50–75%, and 20 (26.7%) scored <50%. Female students demonstrated marginally better performance than males. The highest SI scores were observed for engagement in the learning process (83.89) and studying at one's own pace (80.00). Conclusion: Self-paced learning was associated with good academic performance, satisfactory short-term knowledge retention, and positive learner perceptions. Incorporating structured SPL into undergraduate medical education may strengthen learner engagement and support lifelong learning.
Copyright (c) 2026 Bimoch Projna Paty, Monalisa Panigrahi, Shehnaz Firdaus https://creativecommons.org/licenses/by-nc-nd/4.0
Clinical Profile and Etiological Spectrum of Unilateral Proptosis: A Cross-sectional Observational Study.
Background Unilateral proptosis is an abnormal forward displacement of one globe and can arise from endocrine, inflammatory, vascular, traumatic, or neoplastic disorders. Because the orbit is a confined anatomical space, delayed recognition of the underlying lesion can result in irreversible visual impairment or life-threatening complications. Objectives To describe the demographic, clinical, ophthalmological, investigational, and etiological profile of patients presenting with unilateral proptosis Methods This cross-sectional observational study included 20 patients evaluated through the ophthalmology outpatient and inpatient services of a tertiary care hospital in eastern India from October 2015 to September 2016. Proptosis was measured with a Luedde exophthalmometer. Clinical examination, erythrocyte sedimentation rate, ear-nose-throat assessment, orbital ultrasonography, and computed tomography were undertaken as clinically indicated. Etiologies were classified as endocrine, neoplastic, inflammatory, vascular, or traumatic. Data were summarized descriptively. Results Half of the patients were aged 16–30 years, and 12 (60%) were male. The right eye was involved in 14 (70%) patients, and axial proptosis was observed in 13 (65%). All patients presented with visible protrusion of one eye; restricted extraocular movements occurred in 15 (75%), ocular pain in 8 (40%), and visual impairment in 5 (25%). Thyroid-associated orbitopathy and neoplastic lesions were the joint leading etiological groups, each accounting for 5 (25%) cases. Inflammatory causes accounted for 4 (20%), while vascular and traumatic causes each accounted for 3 (15%). Conclusion Unilateral proptosis showed a broad etiological spectrum, with endocrine and neoplastic conditions occurring most frequently. Careful ophthalmic examination supported by targeted orbital imaging is essential for localization, etiological diagnosis, and protection of vision. Recommendations Patients with unilateral proptosis should undergo prompt, structured evaluation that includes visual assessment, ocular motility testing, exophthalmometry, systemic screening, and orbital imaging guided by the clinical presentation.
Copyright (c) 2026 Dr. Sweety Kumari, Dr. Nivedita Choudhury https://creativecommons.org/licenses/by-nc-nd/4.0
A Study of Evaluation of Serum Leptin and Serum Adiponectin as Biomarkers in Endometrial Carcinoma in Indian Women in a Tertiary Care Hospital: A Cross-Sectional Study.
Background: Endometrial carcinoma is increasingly associated with obesity, metabolic disorders, and adipokine dysregulation. Leptin and adiponectin exert opposing biological effects and may serve as non-invasive biomarkers for tumour aggressiveness and prognosis. This study evaluated serum leptin and adiponectin levels and their association with histopathological parameters in Indian women with endometrial carcinoma. Methods: A cross-sectional observational study was conducted at MKCG Medical College and Hospital, Berhampur, Odisha, from March 2024 to September 2025. Eighty women aged 40–70 years with histopathologically confirmed endometrial carcinoma were enrolled. Pre-treatment serum leptin and adiponectin levels were measured using enzyme-linked immunosorbent assay (ELISA). Associations with tumour grade, FIGO stage, myometrial invasion, disease progression, metastatic status, and prognosis were analyzed. Results: The mean serum leptin level was 9.30 ± 2.39 ng/mL, and the mean adiponectin level was 12.14 ± 4.15 µg/mL. Leptin levels increased progressively with tumour grade (Grade 1: 16.8 ± 5.1 ng/mL; Grade 3: 31.2 ± 8.1 ng/mL) and FIGO stage (Stage IA: 16.9 ± 4.8 ng/mL; Stage IIIC: 31.5 ± 8.8 ng/mL), whereas adiponectin levels decreased inversely. Patients with high disease progression had significantly higher leptin and lower adiponectin levels than those with low progression. The leptin/adiponectin ratio (LAR) was significantly higher in metastatic and poor-prognosis cases. Conclusion: Serum leptin, adiponectin, and particularly the leptin/adiponectin ratio were significantly associated with histopathological aggressiveness, disease progression, metastatic potential, and prognosis in Indian women with endometrial carcinoma. Recommendation: Larger multicenter longitudinal studies should be conducted to validate leptin, adiponectin, and the leptin/adiponectin ratio as prognostic biomarkers and establish standardized clinical cut-off values for routine use in endometrial carcinoma management.
Copyright (c) 2026 Dr. Vibhor Shukla, Sabyasachi Padhi, Dr. Mahija Sahu, Dr. Janmejaya Mohapatra, Dr. Nirupama Devi https://creativecommons.org/licenses/by-nc-nd/4.0
Clinicopathological profile and anaesthetic considerations in patients undergoing surgical management of orthopaedic bone tumours: a hospital-based descriptive cross-sectional study.
Background Orthopaedic bone tumours comprise benign, primary malignant, and metastatic lesions whose surgical management requires integration of clinicopathological diagnosis with anaesthetic planning. Objectives To describe the clinicopathological profile, surgical procedures, anaesthetic techniques, intraoperative concerns, and early postoperative outcomes among patients undergoing surgery for orthopaedic bone tumours. Methods This hospital-based descriptive cross-sectional study was conducted at Government Medical College and Government General Hospital, Rajanna Sircilla, Telangana, India, from December 2025 to April 2026. One hundred consecutive eligible patients undergoing surgery for suspected or histopathologically confirmed bone tumours were included. Demographic, clinicopathological, operative, anaesthetic, blood-loss, transfusion, haemodynamic, and postoperative variables were analysed descriptively. Results The mean age was 34.8 ± 18.6 years; 58 (58.0%) patients were male. Pain was reported by 86 (86.0%), swelling by 62 (62.0%), and restricted movement by 38 (38.0%). The femur was involved in 34 (34.0%) cases. Benign tumours accounted for 46 (46.0%), primary malignant tumours for 34 (34.0%), and metastatic lesions for 20 (20.0%). General anaesthesia was used in 56 (56.0%), regional anaesthesia in 20 (20.0%), and combined techniques in 24 (24.0%). Blood loss exceeded 500 mL in 32 (32.0%), 30 (30.0%) required transfusion, and 18 (18.0%) developed intraoperative hypotension. Rescue analgesia was required in 28 (28.0%), postoperative nausea and vomiting occurred in 12 (12.0%), wound complications in 8 (8.0%), intensive care admission in 2 (2.0%), and re-exploration in 1 (1.0%). No perioperative deaths occurred. Conclusion Bone tumour surgery demonstrated substantial clinicopathological and procedural heterogeneity. Anticipated bleeding, transfusion preparedness, haemodynamic monitoring, multimodal analgesia, and selective critical-care surveillance were the principal anaesthetic considerations. Recommendations Multidisciplinary planning, preoperative optimisation, blood-conservation measures, and protocol-based analgesia should form institutional perioperative pathways.
Copyright (c) 2026 Dr. Radhika Chendragiri, Dr.Annam Sadhana, Dr. Kandukuri Arun https://creativecommons.org/licenses/by-nc-nd/4.0
Evaluation of pathological fractures in orthopaedic practice with emphasis on histopathology and anaesthetic challenges: a hospital-based cross-sectional study.
Background Pathological fractures occur through structurally weakened bone and require coordinated orthopaedic stabilization, histopathological diagnosis, and careful anaesthetic management. Objectives To evaluate the clinical profile, histopathological spectrum, orthopaedic management, anaesthetic challenges, and perioperative complications among patients presenting with pathological fractures Methods A hospital-based descriptive cross-sectional study included 100 consecutive patients with pathological or impending pathological fractures treated at Government Medical College and Government General Hospital, Rajanna Sircilla, Telangana, India, from November 2025 to April 2026. Clinical characteristics, fracture site, histopathological diagnosis, orthopaedic treatment, anaesthetic technique, anaesthetic challenges, and perioperative complications were collected using a structured proforma and summarized using descriptive statistics. Results The mean age was 44.8 ± 17.6 years, and 58.0% of patients were male. Fractures followed trivial trauma in 63.0% of cases, while 21.0% occurred spontaneously and 16.0% were impending fractures. The femur was the most commonly affected bone (48.0%). Malignant lesions accounted for 65.0% of cases, with metastatic carcinoma comprising 38.0% of all diagnoses. Internal fixation was the most common surgical procedure (43.0%). General anaesthesia was used in 52.0% of patients, followed by regional anaesthesia (36.0%). Anaesthetic challenges occurred in 62.0% of patients, mainly preoperative anaemia (34.0%), cardiopulmonary comorbidities (28.0%), anticipated major blood loss (25.0%), and positioning difficulties (22.0%). Perioperative complications were reported in 29.0%, most commonly blood transfusion (18.0%), severe postoperative pain (14.0%), and intraoperative hypotension (12.0%). No intraoperative deaths occurred. Conclusion Malignant bone disease, particularly metastatic carcinoma, was the leading cause of pathological fractures. Histopathological confirmation guided definitive management, while the high prevalence of anaesthetic challenges and perioperative complications highlights the importance of multidisciplinary care and individualized perioperative planning. Recommendations Early multidisciplinary assessment, timely biopsy, optimization of anaemia, adequate blood product preparation, and structured postoperative analgesia are recommended to improve patient outcomes.
Copyright (c) 2026 Dr. Kandukuri Arun, Dr. Annam Sadhana, Dr. Radhika Chendragiri https://creativecommons.org/licenses/by-nc-nd/4.0
Clinical and Functional Outcomes of Patients with Rotator Cuff Tear Managed Conservatively: A Cross-Sectional Observational Study.
Background: Rotator cuff tear is a frequent cause of shoulder pain, restricted overhead activity, and functional impairment among middle-aged and older adults. Conservative management remains an important initial treatment option, particularly for partial-thickness and small-to-medium tears. Objectives: To evaluate clinical and functional outcomes of patients with rotator cuff tears managed conservatively and to assess improvement in pain, shoulder range of motion, and functional scores during follow-up. Methods: This hospital-based cross-sectional observational study included 80 patients with clinically and radiologically diagnosed rotator cuff tears treated conservatively at Government Medical College, Jangaon, Telangana, India, from August 2025 to January 2026. Conservative care included analgesics, activity modification, home-based exercises, supervised physiotherapy, local physical modalities, and corticosteroid injection in selected patients. Pain and function were assessed using the visual analogue scale, Constant-Murley score, American Shoulder and Elbow Surgeons score, and shoulder range of motion at baseline, 3 months, and 6 months. Results: The mean age was 52.8 ± 9.6 years, and males constituted 56.3%. Partial-thickness tear was present in 72.5%, and the supraspinatus was the most commonly involved tendon. The mean VAS pain score decreased from 7.1 ± 1.2 at baseline to 3.2 ± 1.4 at 6 months. The Constant-Murley score improved from 48.6 ± 10.8 to 72.4 ± 12.5, and the ASES score improved from 45.8 ± 11.6 to 76.2 ± 13.4. An excellent or good outcome was observed in 72.5% of patients. Conclusion: Conservative management produced significant pain reduction and functional improvement in most patients with rotator cuff tears. Recommendations: Structured rehabilitation with regular follow-up should be considered as an initial management strategy in suitable patients.
Copyright (c) 2026 Dr. Yugandhar Polepaka, Dr. Balaji Jarpala, Dr. Ramesh Ramineni https://creativecommons.org/licenses/by-nc-nd/4.0
Prognostic significance of early (first 6 hours) versus delayed changes in serum lactate and procalcitonin in septic shock: A prospective observational cohort study.
Background: Sepsis and septic shock are major causes of mortality among critically ill patients. Serum lactate and procalcitonin are important biomarkers for prognostic evaluation and monitoring treatment response. Objective: To assess the prognostic significance of serial changes in serum lactate and procalcitonin and their clearance in predicting outcomes in patients with sepsis and septic shock. Methods: This prospective observational cohort study included 100 adult intensive care unit patients with suspected or confirmed sepsis. Serum lactate was measured at admission, 6, 12, and 24 hours, while procalcitonin was measured at admission and on day 3. Lactate and procalcitonin clearance rates were calculated. Clinical severity was assessed using the Glasgow Coma Scale, Sequential Organ Failure Assessment score, and National Early Warning Score. Results: The mean age was 57.8 ± 13.6 years, 56% were male, and overall mortality was 21%. Non-survivors had significantly higher baseline lactate and procalcitonin levels and markedly lower clearance rates than survivors (p<0.0001). Lactate levels progressively declined over 24 hours in survivors, indicating improved tissue perfusion. Procalcitonin clearance demonstrated excellent diagnostic accuracy for predicting mortality, while higher Sequential Organ Failure Assessment and National Early Warning Score values were associated with poorer outcomes. Conclusion: Elevated serum lactate and procalcitonin levels with reduced clearance are associated with increased mortality in sepsis and septic shock. Serial biomarker monitoring combined with clinical severity scores may improve early risk stratification and prognostic assessment. Recommendation: Routine serial monitoring of lactate and procalcitonin clearance should be incorporated into sepsis management to facilitate early identification of high-risk patients.
Copyright (c) 2026 Mohammad Shoaib, Sourabh Kumar, Ritwik Chakraborty, Shalendra Goel https://creativecommons.org/licenses/by-nc-nd/4.0
Management of Forgotten, Encrusted, and Fragmented Double-J Ureteral Stents: A Prospective Cross-Sectional Observational Study from a Tertiary Care Center.
Background: Forgotten, encrusted, and fragmented double-J ureteral stents represent a preventable yet clinically demanding urological problem. Delayed retrieval increases the risk of stone formation, infection, fragmentation, and the need for combined endourological procedures. Objectives: To evaluate the clinical presentation, pattern of stent encrustation or fragmentation, management strategies, and short-term outcomes among patients treated for forgotten double-J ureteral stents at a tertiary care center. Methods: This prospective observational study included 22 consecutive patients managed at A C Subba Reddy Government Medical College & Hospital, Dargamitta, Nellore, Andhra Pradesh, India, from April 01, 2026, to April 30, 2026. Demographic details, symptoms, stent duration, imaging findings, operative procedures, complications, and clearance outcomes were analysed descriptively. Results: The mean age was 43.6 ± 12.8 years, and females constituted 54.5% of the cohort. The mean retained stent duration was 19.4 ± 9.7 months. Flank pain was the most frequent symptom. Encrusted-only stents were seen in 59.1%, while 27.3% had both encrustation and fragmentation. Ureteroscopy, cystolithotripsy, retrograde intrarenal surgery, and percutaneous nephrolithotomy were used according to encrustation burden. Complete stent clearance was achieved in all patients, with stone-free status in 90.9%. Conclusion: Multimodal endourological management provided high clearance with acceptable morbidity in patients with forgotten, encrusted, and fragmented double-J stents. Recommendations: Structured stent registries, patient counselling, and reminder systems should be implemented to prevent prolonged indwelling time and reduce avoidable complications.
Copyright (c) 2026 Dr. Chenna Sai Krishna, Dr Juturu Jayaraju, Dr Gidion Bangla https://creativecommons.org/licenses/by-nc-nd/4.0
Emphysematous pyelonephritis: outcomes with conservative management in a tertiary care center: A cross-sectional observational study.
Background: Emphysematous pyelonephritis is a severe necrotizing infection of the kidney characterized by gas formation within the renal parenchyma, collecting system, or perinephric tissues. Early recognition and renal-preserving treatment have changed the management approach from routine nephrectomy to conservative strategies in selected patients. Objectives: To evaluate the clinical profile, radiological severity, treatment pattern, and short-term outcomes of patients with emphysematous pyelonephritis managed initially with conservative therapy in a tertiary care center. Methods: This hospital-based observational study was conducted at A C Subba Reddy Government Medical College & Hospital, Dargamitta, Nellore, Andhra Pradesh, India, from April 01, 2026, to April 30, 2026. Thirty-five patients diagnosed with emphysematous pyelonephritis and managed initially with antibiotics, supportive care, glycaemic control, and minimally invasive drainage where indicated were included. Clinical variables, CT classification, management modality, and outcomes were analysed descriptively. Results: The mean age was 55.1 ± 10.9 years, and females constituted 62.9% of patients. Diabetes mellitus was present in 85.7%, obstructive uropathy in 40.0%, and hypertension in 37.1%. Fever and flank pain were the commonest symptoms. Class 2 disease was the most frequent CT category. Conservative management was successful in 29 patients, giving a renal salvage rate of 82.9%. Delayed nephrectomy and mortality occurred in three patients each. Conclusion: Conservative management achieved favourable outcomes in most patients when combined with early antibiotics, metabolic correction, and timely drainage. Recommendations: Early CT-based risk stratification, prompt glycaemic control, urine culture-directed antibiotics, and low-threshold minimally invasive drainage are recommended to improve renal salvage.
Copyright (c) 2026 Dr Juturu Jayaraju, Dr. Chenna Sai Krishna, Dr V. Mary Snygdha https://creativecommons.org/licenses/by-nc-nd/4.0
Filariasis on cytology of clinically unsuspected sites trapped accidentally on aspiration – A challenge ahead.
Background Incidental detection of microfilariae in fine-needle aspiration cytology (FNAC) specimens from clinically unsuspected sites is uncommon but clinically important, particularly in filariasis-endemic regions. This study evaluated the clinicopathological spectrum of incidental filariasis detected on FNAC and highlighted the diagnostic utility of cytology in identifying occult infections. Materials and Methods This retrospective observational study included 33 cases of incidental microfilarial detection on FNAC diagnosed at the Department of Pathology, Patna Medical College and Hospital, India, between January 2012 and January 2022. Clinical details, anatomical sites, cytomorphological findings, peripheral blood smear results, and eosinophil counts were reviewed. Cases with peripheral blood microfilaremia were excluded. Results Thirty-three patients (20 males and 13 females; age range: 12–80 years) were studied. Microfilariae were detected in subcutaneous swellings (n=8), breast lesions (n=7), lymph nodes (n=7), liver lesions (n=4), mediastinal masses (n=2), and single cases involving the thyroid, lung, gallbladder, periampullary region, and parietal wall. None of the patients had clinical suspicion of filariasis before cytological examination. Eight cases were associated with malignant lesions, while the remainder occurred with benign or inflammatory conditions. Peripheral blood smears were negative in all cases, and eosinophilia was present in only seven patients. Conclusion FNAC is a rapid, minimally invasive, and cost-effective modality for detecting occult filariasis at clinically unsuspected sites. Microfilariae may coexist with a wide range of benign and malignant lesions even in the absence of peripheral microfilaremia or eosinophilia. Recommendation Routine and meticulous screening of all cytology smears for microfilariae is recommended in endemic regions irrespective of clinical suspicion, as early detection facilitates timely treatment and appropriate management of associated lesions.
Copyright (c) 2026 Dr. Richa Bhartiya , Dr. Pallavi Mehra, Dr. Vishal Tayade, Dr. Dipika Bongale, Dr. Manasi Karwa , Dr. Navin Kumar Bariar https://creativecommons.org/licenses/by-nc-nd/4.0
Evaluation of Serum Biomarkers in Predicting the Severity of Community-Acquired Pneumonia: A Prospective Cross-Sectional Observational Study.
Background: Community-acquired pneumonia (CAP) remains a major cause of morbidity and mortality worldwide. Early identification of severe cases is essential for timely intervention and improved outcomes. Serum biomarkers such as C-reactive protein (CRP), procalcitonin (PCT), neutrophil-to-lymphocyte ratio (NLR), and serum lactate have emerged as valuable tools for assessing disease severity. Aim: To evaluate the role of serum biomarkers in predicting the severity of community-acquired pneumonia and their correlation with established clinical severity scores. Methods: A prospective observational study was conducted among 100 patients diagnosed with CAP admitted to Madhubani Medical College and Hospital, Madhubani, between April 2025 and January 2026. Serum CRP, procalcitonin, NLR, and lactate levels were measured at admission. Severity was assessed using CURB-65 and Pneumonia Severity Index (PSI) scores. Biomarker levels were compared between severe and non-severe CAP groups. Results: Among 100 patients, 62% were males and 38% females. Thirty-five patients had severe CAP. Mean CRP, PCT, NLR, and lactate levels were significantly higher in severe CAP compared to non-severe CAP (p<0.001). Procalcitonin demonstrated the highest predictive accuracy for severe disease (AUC=0.89), followed by lactate (AUC=0.86), CRP (AUC=0.83), and NLR (AUC=0.80). Conclusion: Serum biomarkers, particularly procalcitonin and lactate, are valuable predictors of CAP severity and correlate strongly with clinical severity scores. Their incorporation into routine assessment may facilitate early risk stratification and optimize patient management. Recommendation: Routine assessment of procalcitonin and serum lactate, alongside conventional severity scores, is recommended for early risk stratification and identification of patients requiring intensive monitoring and aggressive management.
Copyright (c) 2026 Dr. Ashutosh Kumar, Dr. Mukesh Kumar, Dr. Ajay Kumar Lal Das https://creativecommons.org/licenses/by-nc-nd/4.0
Diagnostic Accuracy of Artificial Intelligence Expert Systems for Ear, Nose, and Throat Diseases: A Prospective Cross-Sectional Observational Study.
Background: Artificial Intelligence (AI)-based expert systems are increasingly being explored as decision-support tools in clinical practice. Their application in Ear, Nose, and Throat diseases may improve early diagnosis and facilitate timely referral, particularly in resource-constrained settings. Objective: To evaluate the diagnostic accuracy of an Artificial Intelligence expert system in patients presenting with Ear, Nose, and Throat diseases by comparing AI-generated diagnoses with final diagnoses established by consultant ENT specialists. Methods: A prospective cross-sectional observational study was conducted in the Department of Ear, Nose, and Throat and Head-Neck Surgery of a tertiary care teaching hospital from March 2025 to February 2026. A total of 150 patients presenting with various ENT complaints were included using consecutive sampling. Clinical information was entered into the AI expert system, and the generated diagnoses were compared with final diagnoses made by consultant ENT specialists. Sensitivity, specificity, positive predictive value, negative predictive value, and overall diagnostic accuracy were calculated. Results: The AI expert system demonstrated good agreement with specialist diagnoses and showed satisfactory diagnostic performance across common ENT conditions. The system achieved high sensitivity and specificity for frequently encountered disorders, supporting its utility as an adjunctive diagnostic tool in clinical practice. Conclusion: Artificial Intelligence expert systems demonstrated promising diagnostic accuracy for Ear, Nose, and Throat diseases and may serve as valuable decision-support tools alongside specialist clinical assessment. Recommendation: AI expert systems may be utilized for preliminary screening, triage, and referral support in ENT practice, especially in settings with limited specialist availability. Further multicenter studies involving larger populations are recommended to validate these findings.
Copyright (c) 2026 Jitendra Pratap Singh Chauhan, Kanchan Chaudhary, Jyoti Kumar Verma https://creativecommons.org/licenses/by-nc-nd/4.0