ISSN: e-ISSN - 2456- 2785 Discipline: All Medical, Surgical and Dental Specialities Starting Year: 2016 Current volume: Volume 11 Issue per year: 4 issues Editor-in-chief: Dr. Sayan Bhattacharyya, India Indexing: Index Copernicus, Journal Guide, Research Bible, World Cat, Sherpa Romeo, Google Scholar E-mail: editor.ejms@mansapublishers.com
Polyphenol-Based Interventions in NAFLD: A Critical Analysis of TherapeuticEfficacy, Molecular Mechanisms, and Clinical Translation Barriers
Background: Non-Alcoholic Fatty Liver Disease (NAFLD) is a chronic condition commonly associated with obesity and metabolic syndrome. Polyphenolic compounds, such as resveratrol and curcumin, have emerged as potential therapeutic agents due to their antioxidant and anti-inflammatory properties. Objective: This review aims to critically evaluate the therapeutic potential of resveratrol and curcumin in the management of NAFLD, focusing on their molecular mechanisms and clinical implications. Methods: The mechanisms through which resveratrol activates the AMPK and SIRT1 pathways to improve lipid metabolism and reduce oxidative stress are explored. Similarly, curcumin’s role in suppressing pro-inflammatory markers like TNF-α and IL-6 is examined. Results: Both resveratrol and curcumin demonstrate significant antioxidant and anti-inflammatory effects, contributing to improved liver function and lipid homeostasis. However, clinical translation of these compounds has been limited by challenges such as poor bioavailability, inconsistent dosing, and varying therapeutic outcomes. Conclusion: Despite these limitations, polyphenols show promise as adjunctive treatments for NAFLD. Advanced drug delivery systems and standardized therapeutic protocols are necessary to enhance their clinical efficacy. Further research is required to optimize the use of polyphenols in clinical practice.
Copyright (c) 2026 Manikandan A, Mukesh J, Senthil M http://creativecommons.org/licenses/by-nc-nd/4.0
Effectiveness of ginger in the management of arthritis- A systematic review of randomized controlled trials
Background/objectives: Arthritis is a chronic, debilitating disease that affects patients’ daily lives due to stiffness, pain, and restricted mobility. Natural medicines such as ginger (Zingiber officinale) are reported to improve arthritis symptoms and provide significant pain relief. This review aimed to evaluate the available clinical evidence on ginger’s therapeutic role in arthritis as a standalone treatment or an adjunct and to assess its safety profile. Methods: This PRISMA-guided systematic review includes randomized controlled trials in which ginger was used as a standalone intervention for pain management in osteoarthritis or rheumatoid arthritis, or that included placebo or control groups. Studies were included if they reported pain relief measured using the Visual Analog Scale (VAS) or the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). We screened articles from six databases: PubMed, SCOPUS, COCHRANE, ScienceDirect, EMBASE, and ClinicalTrials.gov. A total of 613 studies were screened, and seven studies were included in the final analysis. Results: Of the seven studies, two used a crossover design, one was open-label, one was a placebo-controlled parallel-group trial, and three were double-blind placebo-controlled trials. Different studies used various measures to assess pain relief after ginger therapy (VAS in two studies, WOMAC in one, KOSS in one, and both the WOMAC and VAS scales in two studies). All but one study has shown the beneficial role of ginger therapy in relieving pain in patients with arthritis. Conclusion: Ginger supplementation can be a therapeutic option in managing arthritis symptoms, particularly in improving pain and functional outcomes. The anti-inflammatory and antioxidant properties of ginger's bioactive compounds provide a plausible mechanism for these effects. However, further research is needed to establish optimal dosing regimens, long-term efficacy, and safety profiles. Protocol Registration: PROSPERO: CRD42025631420.
Copyright (c) 2026 Sindhuprava Rana, Amit Agrawal, Babita Raghuwanshi, Saikat Das, Vishnu G Kartha, Amit Agrawal http://creativecommons.org/licenses/by-nc-nd/4.0
The role of AI in Detection and Diagnosis of Kidney stone
Background: Kidney stone disease (nephrolithiasis) is a prevalent and recurrent condition, affecting approximately 12–15% of the Indian population. Conventional diagnostic modalities such as computed tomography (CT), ultrasound (US), and X-ray imaging are widely used but have notable limitations, including radiation exposure, operator dependency, variability in interpretation, and reduced sensitivity for small or radiolucent stones. Objective: To evaluate the role of artificial intelligence in the detection and diagnosis of kidney stones across various imaging modalities and clinical applications. Methods: This narrative review evaluates recent studies on AI applications in nephrolithiasis, focusing on machine learning (ML) and deep learning (DL) techniques applied to imaging modalities (CT, US, X-ray), clinical prediction models, and advanced analytical methods such as spectroscopy and microscopy. Results: AI-based models significantly enhance diagnostic performance by enabling automated detection, segmentation, and characterization of kidney stones, achieving accuracies exceeding 90% in several studies. AI improves imaging interpretation across CT, US, and X-ray while reducing observer variability and enabling low-dose imaging protocols. Additionally, AI demonstrates strong predictive capabilities for clinical outcomes, including spontaneous stone passage, extracorporeal shock wave lithotripsy(ESWL) success, and endourological procedure outcomes, often outperforming traditional statistical models. AI also enables accurate identification of stone composition through imaging data and advanced analytical techniques, supporting personalized treatment strategies. Conclusion: Artificial intelligence represents a transformative advancement in kidney stone management by improving diagnostic accuracy, reducing variability, and facilitating personalized care. However, further large-scale validation and integration into clinical workflows are required to ensure widespread adoption and optimal patient outcomes.
Copyright (c) 2026 Tamil Eniyan AKM, Premkumar Gopalsamy, Senthil M http://creativecommons.org/licenses/by-nc-nd/4.0
Hypoplastic posterior mitral leaflet associated with ostium secundum atrial septal defect
Hypoplastic posterior mitral leaflet is a congenital dysplastic mitral valve abnormality rarely reported in adults. The presentation is varied, from being asymptomatic to significantly symptomatic due to progressive mitral regurgitation. In many of these cases additional cardiac lesions are noted, most commonly, bicuspid aortic valve and atrial septal defect. Hence, while performing imaging assessment for these conditions, a comprehensive evaluation of the mitral valve apparatus is essential so as not to miss the valvular pathology. The ideal therapeutic approach and timing for intervention in hypoplastic posterior mitral leaflet is still not clear due to a rarity of these cases. Mitral valve repair though preferred, may not be the ideal treatment modality and many patients require mitral valve replacement especially when presenting at an older age. We hereby report about a 56-year-old male patient who was diagnosed with ostium secundum atrial septal defect and hypoplastic posterior mitral leaflet. He underwent successful surgical closure of the atrial septal defect and concomitant bileaflet metallic prosthetic mitral valve replacement. His postoperative course was uneventful and was associated with amelioration of symptoms during follow-up.
Copyright (c) 2026 Jaideep Dey, Amita Garg, Arif Mustaqueem, Ramji Mehrotra, Sameer Shrivastava http://creativecommons.org/licenses/by-nc-nd/4.0
The relationship between age and DNA fragmentation index: Use of sperm chromatin dispersion assay to evaluate the sperm DNA fragmentation
Objective: To evaluate sperm DNA fragmentation using the sperm chromatin dispersion (SCD) assay in a large retrospective cohort and to assess age-related patterns of DNA damage. Methods: This retrospective observational study included 456 semen samples obtained from male partners of infertile couples. Sperm DNA fragmentation was assessed using the SCD method, and the DNA fragmentation index (DFI) was calculated as the percentage of spermatozoa showing the absence of halo formation and degraded nuclei. Participants were stratified into four age groups (≤30, 31–35, 36–40, and >40 years). Mean DFI values and the prevalence of abnormal DFI (≥25% and ≥30%) were analyzed across the age groups. Results: Mean DFI values did not differ significantly among age groups (p=0.637). Correlation analysis showed a weak, non-significant association between age and DFI. However, the proportion of samples with abnormal DFI (≥25%) increased progressively with age, reaching 55.4% in men older than 40 years. A similar trend was observed for severe DNA fragmentation (DFI ≥30%). Conclusion: Although mean DFI values were comparable across different age groups, advancing age was associated with a higher prevalence of clinically significant sperm DNA fragmentation. These findings support threshold-based interpretation of DFI and highlight the clinical utility of SCD testing in routine male infertility evaluation, particularly in older individuals.
Copyright (c) 2026 Suryaprakashrao Kunda, Mukkanteswararao kasaragadda, sambasivarao patibandla, Shalini Singh http://creativecommons.org/licenses/by-nc-nd/4.0
Menopausal Transition and the Effect of Ayurvedic Treatment
Menopausal symptoms are common for almost 90% of women need. Vasomotor symptoms like hot flashes, puffiness on the face and lower limbs, and psychological conditions like mood swings, vaginal dryness, dyspareunia, and depression are common during the menopause. Irregular cycles with the above symptoms from menopausal transition till cessation can be treated with the clinical approach of hormone therapy, nonhormonal ayurvedic drug regimen, with lifestyle changes. The purpose of this study was to present an integrated approach to navigate the challenges in treating menopausal symptoms. Case report: A 47-year-old female patient presented with menopausal symptoms for 4 years. Ayurvedic Treatment was given according to pitta dosh prakop (heat,inflammation) and vat dosh vrudhi (dryness, instability, nervous energy). Results: After 6 months of treatment, symptoms were reduced to manageable levels, the lipid profile improved, and uterine wall thickness decreased. Conclusion: Ayurvedic principles of Rasayana, Vata Shaman, and Kapha Vardhan, along with Panchakarma, Sadvrutaa, balanced diet, Yoga, and meditation, can be used for the management of menopausal symptoms.
Copyright (c) 2026 Jyoti Bandewar http://creativecommons.org/licenses/by-nc-nd/4.0
A Rare Stroke due to a Rare Mechanism- Embolic Recurrent Artery of Heubner Infarct
Copyright (c) 2026 Anandhu Suresh, Sajeesh Rajendran, Somarajan Anandan, Sourav Asha Somarajan http://creativecommons.org/licenses/by-nc-nd/4.0
The Interplay between Chronic Kidney Disease and Cardiovascular Disease: Mechanisms, Biomarkers, and Management
Chronic kidney disease (CKD) and cardiovascular disease (CVD) share a bidirectional relationship that accelerates global morbidity and mortality. This review synthesizes the mechanisms underlying cardiorenal syndrome, highlights advance in diagnostic biomarkers and evaluates both established and emerging therapeutic strategies for managing the CKD–CVD interplay. Literature from PubMed, Scopus, and Google Scholar databases (2000-2025) was systematically searched for human studies on heart–kidney physiology, CKD-driven cardiovascular complications, biomarker development, and therapeutic interventions. CKD significantly increases cardiovascular risk via pathophysiological processes including persistent hypertension, oxidative stress, systemic inflammation, endothelial dysfunction, vascular calcification, and uremic toxin accumulation. The spectrum of cardiorenal syndrome (types 1–5) underscores the intricacy of cardiorenal crosstalk. Advances in biomarker research, notably serum creatinine, cystatin C (CysC), neutrophil gelatinase-associated lipocalin (NGAL), and metabolomic profiling have enabled more precise risk assessment and early detection. Traditional approaches focus on blood pressure control and proteinuria reduction through renin–angiotensin–aldosterone system (RAAS) blockade, mineralocorticoid antagonism, and diuretic use. Novel therapies seek to target disease drivers including fibrotic transformation, inflammation, and gut–kidney axis disruption. The reciprocal relationship between CKD and CVD demands early recognition, adoption of innovative biomarkers, and application of integrative management strategies. Enhancing disease awareness and fostering multidisciplinary care are vital to alleviating the global impact of cardiorenal syndrome.
Copyright (c) 2026 Khushi T. Bhogan, Bhumika R. Chavan, A. M. Kane, Vrutti G. Karalkar, Krutika C. Khanolkar, Shraddha M. Parab, V. A. Jagtap http://creativecommons.org/licenses/by-nc-nd/4.0
Therapeutic Potential of melatonin as an anti-obesity agent Melatonin as an anti-obesity agent
Obesity is a major healthcare crisis, with the number rising each year, which is concerning. Obesity is associated with many metabolic syndromes, heightening the risk of Type 2 diabetes mellitus, cardiovascular diseases, stroke, fatty liver, and hypertension. This imposes a substantial burden on healthcare systems, with escalating annual costs. Current management strategies for obesity include lifestyle interventions, bariatric surgery, and pharmacotherapy. Lifestyle management often results in modest weight loss. Bariatric surgery, while effective in achieving significant weight loss, is limited by risks and accessibility. Different FDA-approved pharmacotherapies are also available, but there are some limitations. Emerging research highlights melatonin as a promising therapy for obesity treatment due to its multifaceted mechanisms. Melatonin's potential benefits include regulating metabolic processes, suppressing appetite, improving insulin sensitivity, exhibiting antioxidant and anti-inflammatory effects, and modulating circadian rhythms. Recent studies suggest that melatonin supplementation may contribute effectively to obesity management by impacting weight loss, appetite regulation, and insulin resistance. This review aims to evaluate the physiological effects of melatonin in obesity therapy, focusing on its impact on metabolic health, appetite control, and insulin sensitivity while acknowledging the need for further research in this area.
Copyright (c) 2025 Mayank Dhalani, Abhinav Malik, Simran Dahiya, Kanishk Aggarwal, Rohit Jain http://creativecommons.org/licenses/by-nc-nd/4.0
C3 Glomerulonephritis at the crossroads of Diabetes and Renal Failure: A Case Report
C3 glomerulopathy (C3G) is a rare complement-mediated kidney disease characterized by dominant C3 deposition in the glomeruli, with C3 glomerulonephritis (C3G) and dense deposit disease (DDD) as its two main subtypes. We present the case of a 66-year-old female with known C3G on maintenance hemodialysis, complicated by diabetes, hypertension, and diabetic foot ulcer. She had large hematuria, significant proteinuria, severe renal failure, and a noticeably increased serum creatinine level. In addition to early diabetic nephropathy and chronic renal alterations, kidney biopsy confirmed C3GN with a diffuse endocapillary proliferative pattern, crescent development, significant C3 deposition, and lack of immunoglobulins. Hemodialysis, antihypertensives, steroids, renal-supportive drugs, and insulin treatment were used to treat her. In addition to highlighting the difficulties in treating advanced C3G, this case adds to the limited information on this rare illness and underscores the diagnostic value of kidney biopsies.
Copyright (c) 2025 Pramod G R, Rosch Ha Shanna G Kharmalki, Ajay R http://creativecommons.org/licenses/by-nc-nd/4.0
Prevalence and Changing Trend of Dengue in a Tertiary Care Hospital in Southeastern Rajasthan
Background: Dengue is a major mosquito-borne viral disease with increasing incidence in India, showing marked seasonal and year to-year variation. Southeastern Rajasthan has experienced recurrent outbreaks, highlighting the need for continuous surveillance. Aim: To determine dengue seropositivity by NS1 antigen and anti- dengue IgM antibody detection through ELISA, and to correlate the results with evolving epidemiological trends. Materials and Methods: A cross -sectional study done from November2021 to April 2024 with blood samples tested from clinically suspected cases of dengue virus infection. Results: Out of 652 samples tested, 215 (32.97%) were positive. Seropositivity was highest in 2021–22 (47.0%), declined in 2022–23 (13.37%), and resurged in 2023–24 (36.77%). The most affected age group was 16–30 years, with predominance during the post-monsoon season and higher positivity in rural areas. Conclusion: Prevalence of dengue seropositive cases was 55 (47.00%) in 2021- 2022 it was 22 (13.37%) in 2022-2023, in 2023-2024 was 138(36.77%) indicating fluctuating trends of dengue transmission, with an initial peak, a significant decline, and a subsequent resurgence.
Copyright (c) 2025 Jyoti Rana Jyoti Rana, Jyoti Rana; Dr. Yogendra K. Tiwari, Dr. Deepti Dashora http://creativecommons.org/licenses/by-nc-nd/4.0
Old and Modern Identification Techniques of medically important yeasts
Yeasts are unicellular fungal elements. Yeasts may exist as such, or may be found at 37 C in thermally dimorphic fungi like Histoplasma capsulatum and Talaromyces marneffei. They are often encountered in the clinical microbiology setting from various kind of clinical specimens like urine, cerebrospinal fluid (CSF), and blood. Medically important yeasts are Candida albicans, Candida auris, Malassezia furfur and Cryptococcus spp. They are incriminated in various infections like oral thrush, fungemia, meningitis and cystitis. Many a times they are also encountered as normal inhabitants of the human skin and mucosa. Various degrees of immunosuppression in people, in the form of neutropenia or low CD4 T cell count may predispose a susceptible host to develop infections caused by yeasts. They need to be identified correctly for epidemiological purposes and also for institution of correct empirical antifungal therapy. Many old and new techniques have hence been described in the scientific literature for yeast identification. Old techniques like observation of shape and size, Germ tube test using pooled human serum, observing microscopic morphology by Dalmau slit culture, thermotolerance, CHROM agar, lecithinase and lipase production on egg yolk agar, sugar fermentation and sugar assimilation may need a lot of time and expertise, and may yield non-specific results, too. Modern technologies for yeast identification, like MALDI-TOF and Whole genome sequencing, are, hence fast replacing existing ones in this regard, by dint of their rapidity, low cost at times and precision. In this review we have tried to collate, assimilate and present available techniques for yeast identification.
Copyright (c) 2025 Dr. Sayan Bhattacharyya http://creativecommons.org/licenses/by-nc-nd/4.0
Allergy Burden in Gujarat: A Community Portrait of Adult Experiences
Background: Allergies aren’t just a health issue; they disrupt daily life, work, and social interactions. With over a third of adults affected and many unaware of their condition, there’s a pressing need for better diagnosis, education, and environmental policies. Addressing allergies means improving lives, not just treating symptoms. Allergic diseases present a significant public health issue in India. The increasing prevalence is attributed to several factors, including environmental, genetic, and lifestyle-related factors. Objective: This study aimed to determine the prevalence of self-reported allergic conditions among adults in Vadodara, Gujarat, and assess their associations with environmental and demographic factors. Material and Methods: A cross-sectional study was conducted among 474 adults (aged 18–65) using a structured questionnaire based on international health assessment tools. Data on demographics, allergy symptoms, lifestyle factors, and environmental exposures were collected and analyzed. Results: The overall prevalence of allergic conditions was 33.7%, with 161 of the 474 participants affected, with allergic rhinitis (23.2%) being the most common, followed by allergic conjunctivitis (11.6%), skin allergies (11.2%), and food allergies (10.5%) and asthma (7.1%). A positive family history was found to be associated with the development of allergies (OR = 4.69, p < 0.0001), and the prevalence was significantly higher among urban populations (39.5% vs. 24.0%, OR = 1.8, p = 0.019). Conclusion: The research indicates a significant prevalence of allergic conditions in Gujarat adults and demonstrates the role of environmental and lifestyle exposures to allergy. The study shows the importance of public health interventions, pollution control measures, and enhanced healthcare resources.
Copyright (c) 2025 Shah Ashka P, Desai Om B, Patel Shrujal P, Dhalani Mayank H, Patel Anand K http://creativecommons.org/licenses/by-nc-nd/4.0
Laparoscopic common bile duct exploration with antegrade stenting – A case report with review of literature
Endoscopic retrograde cholangiopancreatography (ERCP) is the preferred therapeutic modality for treating common bile duct (CBD) stone/s. It has since evolved significantly with the progressive refinement of endoscopes, endoscopic accessories, and endoscopic techniques, becoming a standardized effective procedure that has benefited many patients with choledocholithiasis. Many international surgical publications have also underscored the important, effective, and pragmatic role played by common bile duct exploration surgery as a valid alternative to endo-therapy; from time to time. These papers pitch surgery as the first therapeutic option over endoscopy for bile duct stones. But in the majority of the health care institutions around the world, endo-therapy is the preferred first step. However, it is a highly advanced procedure which can sometimes fail due to various reasons – technical, logistical, or anatomical. In such cases, a redo is usually attempted after 48 hours. If this also does not succeed, a surgical exploration of the common bile duct (open, laparoscopic, or robotic) may be required for choledocholithiasis. Herein, the authors describe one such case of a 75-year- old gentleman who presented with cholelithiasis and choledocholithiasis. During the initial two attempts at ERCP made by the gastroenterologist, deep selective cannulation of the CBD could not be achieved. It was then decided to perform a laparoscopic CBD exploration and cholecystectomy. The surgery and postoperative recovery was uneventful, and over a 1-year postoperative period, the patient remains asymptomatic.
Copyright (c) 2025 Ravneet Kaur, Abhijit Sharadchandra Joshi http://creativecommons.org/licenses/by-nc-nd/4.0
Shifting Patterns of Hepatitis C Transmission in Duhok: The Emerging Role of Injection Drug Use and a Warning Signal for Iraq
Hepatitis C virus (HCV) remains a significant public health concern globally, especially in low- and middle-income countries such as Iraq. In Iraq, while blood transfusion has historically been the main route of HCV transmission, recent observations in Duhok City suggest a growing shift toward injection drug use (IDU) as an emerging and increasingly dominant risk factor. This shift marks a critical public health turning point, as newly diagnosed HCV cases are now frequently associated with a history of injecting drugs. The rise in IDU raises concerns due to its strong association with bloodborne infections, including HCV, HBV, and HIV, as well as various systemic barriers to care, such as legal restrictions, stigma, lack of harm reduction services, and centralized healthcare delivery. Despite these challenges, highly effective and affordable treatments for HCV exist, and studies show similar cure rates among people who inject drugs compared to the general population. To mitigate the emerging threat, the article calls for comprehensive, evidence-based interventions such as harm reduction services, decentralized HCV care, public education, and enhanced surveillance. Addressing IDU-linked HCV transmission now is essential to prevent a larger epidemic and align with WHO’s 2030 elimination goals.
Copyright (c) 2025 Nawfal R Hussein, Halder J Abozait, Ahmed A Mosa http://creativecommons.org/licenses/by-nc-nd/4.0
Autoimmune Enteric Neuropathies: A Narrative Review of Diagnostic Strategies and Immunotherapeutic Approaches for Gastrointestinal Dysmotility
Background: Autoimmune enteric neuropathies (AENs) are rare but potentially reversible causes of severe gastrointestinal dysmotility, frequently overlooked or misdiagnosed as functional or obstructive disorders. They often present as gastroparesis, chronic constipation, or intestinal pseudo-obstruction, leading to diagnostic delays and poor outcomes. Methods: We conducted a narrative review of the literature using PubMed, EMBASE, and Scopus (2000–2024), focusing on clinical, diagnostic, immunologic, and therapeutic data relevant to AEN. Search terms included “autoimmune enteric neuropathy,” “enteric ganglionitis,” “gastrointestinal dysmotility,” “immunotherapy,” and “paraneoplastic.” Results: AENs require a multimodal diagnostic approach, including anti-neuronal antibody testing (e.g., anti-Hu, anti-CV2), full-thickness intestinal biopsy, and exclusion of structural disease. Paraneoplastic forms, especially those associated with small cell lung carcinoma, and idiopathic variants remain the most common. Immunomodulatory therapies such as corticosteroids, intravenous immunoglobulin (IVIG), azathioprine, and rituximab have shown variable success, particularly when initiated early. Recent advances include trials of subcutaneous immunoglobulin, interleukin inhibitors, JAK inhibitors, and neuro-regenerative strategies. However, evidence remains limited, predominantly comprising case reports and small series. Conclusions: This review highlights AENs as an under-recognized but treatable cause of gastrointestinal dysmotility, with emerging therapeutic strategies showing promise in refractory cases. Critical gaps persist regarding diagnostic consensus, biomarker validation, and standardized treatment. Multidisciplinary approaches, earlier serological testing, and prospective clinical trials are urgently needed. Enhancing clinician awareness could transform outcomes in.
Copyright (c) 2025 Sai Nikhitha Malapati http://creativecommons.org/licenses/by-nc-nd/4.0
Asthma and Medication Administration Practices in Children: An Exploratory Study on Bacterial Colonization of Inhaler Spacer Devices
Introduction: Asthma is one of the most common chronic respiratory diseases in children, and the use of metered dose inhalers (MDIs) with spacers is central to its management. However, these spacer devices, if not cleaned regularly, may become contaminated with bacteria that can worsen asthma symptoms or lead to respiratory infections. This study aimed to evaluate the level of bacterial contamination in MDI spacer devices used by children with asthma and to explore how cleaning habits influence this contamination and associated health outcomes. Methods: We conducted a hospital-based cross-sectional study involving 200 children with asthma who had been using MDI spacers for at least three months. Swabs were collected from the inner surfaces of their spacer devices and cultured on standard media. Bacterial colonies were identified using Gram staining and biochemical tests. Contamination levels were classified based on colony-forming unit (CFU) counts. Associations between contamination, cleaning methods, and hospital admissions were analyzed using appropriate statistical tools. Results: Out of 200 devices, 70 (35%) showed bacterial growth. While many cultures grew Micrococcus spp., potentially harmful bacteria such as E. coli, Klebsiella pneumoniae, Pseudomonas aeruginosa, and Staphylococcus aureus were also found. Children whose devices were cleaned after every use had significantly fewer hospital admissions than those whose devices were only cleaned occasionally or never. Despite receiving cleaning instructions, most caregivers did not follow proper cleaning routines. Conclusion: The study reveals that a substantial number of pediatric asthma spacer devices are contaminated with bacteria, including pathogenic strains, largely due to inconsistent cleaning practices. These findings emphasize the need for better caregiver education and standardized spacer hygiene protocols to reduce infection risk and enhance asthma control in children.
Copyright (c) 2025 Sai Geethika Malapati, Sai Nikhitha Malapati, Pushpalatha K, Basil Nduma, Chukwuyem Ekhator, Ravi GS http://creativecommons.org/licenses/by-nc-nd/4.0
Laparoscopic repair of amyand hernia – A case report with review of literature
Amyand's hernia is a rare condition in which the appendix becomes incarcerated within an inguinal hernia. Although this type of hernia is uncommon, it can lead to serious complications such as strangulation and perforation when the appendix becomes trapped. Incarceration of the appendix is most frequently observed in inguinal and femoral hernias, but it can also occur, though less commonly, in incisional and umbilical hernias. This case report describes an 83-year-old male, who was diagnosed with a right inguinal hernia and underwent laparoscopic hernia repair. Intraoperatively, a right-sided Amyand’s hernia was identified. Since the appendix was not inflamed, it was reduced and a mesh plasty was performed to repair the hernia. The patient had an uneventful recovery.
Copyright (c) 2025 Prachi Praveen Agrawal, Abhijit S Joshi http://creativecommons.org/licenses/by-nc-nd/4.0
Refractory Helicobacter pylori infection after standard triple drug therapy: A case report highlighting diagnostic and therapeutic dilemmas
Helicobacter pylori is a gram-negative bacterium affecting nearly half of the global population and has been proven as a significant risk factor for gastric carcinoma and pathologies related to the stomach, i.e., gastritis, peptic ulcer disease, and MALT (mucosa-associated lymphoid tissue lymphoma). A major concern for managing H. pylori infection is its significantly increasing resistance to guideline-recommended first-line therapy, which is subsequently causing chronic inflammation and an eventual progression to carcinoma. There are several other factors which also affect the possible outcome of the treatments other than antibiotic resistance, i.e., sensitivity and specificity of tests, timing of retesting after eradication therapy, refractory and recurrent infection, and inadequate acid suppression. MALT lymphoma is the most common malignancy associated with H. pylori; on the other hand, its complete remission is possible in more than 50% of cases after eradicating therapy. This case report is of a middle-aged woman who had continued positive antigen testing even after completion of standard guideline-recommended three different regimens for H. pylori infection. After the third regimen, mild symptom improvement was reported, and there was a negative result for biopsy obtained through EGD despite a positive antigen test, as mentioned before. This complexity in management emphasizes how difficult it is to treat recurrent infection and the importance of knowledge of the recommended guidelines to achieve eradication. Simultaneously, there is always an increasing chance of chronic inflammation as symptoms are lasting longer due to a delay in eradication. Therefore, early treatment after diagnosis must be considered. Shared decision making, compliance with therapy, hand hygiene, breaking the chain of transmission between intrafamilial members, and health education are also crucial steps in management.
Copyright (c) 2025 Smit Kotadiya, Ernestine Faye Tan, Madhav Changela, Kalpana Panigrahi http://creativecommons.org/licenses/by-nc-nd/4.0
Revolutionizing Constipation Treatment: The Role of Oral Vibrating Capsules and Beyond - A Narrative Review
Constipation has been a prevalent global problem affecting around 2.5 million people, with 92,000 hospital admissions in the US, with spending amount more than $1 billion annually. It is a significant cause of morbidity, especially in the geriatric population, resulting in extended hospital stays and institutional care settings. In response to this worrying trend, various pharmacological and non-pharmacological interventions have been embraced to produce promising outcomes focusing on a multifaceted approach tailored to individual needs. Non-pharmacological measures include dietary and lifestyle changes, such as increasing fiber consumption, staying hydrated, and engaging in regular physical activity with biofeedback therapy and pelvic floor rehabilitation. In addition to the non-pharmacological therapies, over-the-counter laxatives provide momentary relief, while prescription drugs are used for severe cases or underlying disorders. Despite the various available conventional pharmacological and non-pharmacological therapies recently, an oral vibrating capsule (VC) was approved by the US Food and Drug Administration (FDA) in August 2022 to treat chronic idiopathic constipation in individuals who have not found relief from current laxative medicines for at least a month The vibrating capsule (VC) works on the principle of psychotherapeutics that increases motility and colonic peristalsis and reduces constipation and related symptoms in individuals with Chronic Idiopathic Constipation.
Copyright (c) 2025 Smriti Kochhar , Kanishk Aggarrwal, Pramil Cheriyath, Baltej Aulakh, Rohit Jain http://creativecommons.org/licenses/by-nc-nd/4.0
Innovative Liposomal Vitamin C by West Bengal Chemical Industries Ltd., Kolkata, India: Enhancing Nutraceutical Effectiveness
Objective: To evaluate the physicochemical properties, stability, and absorption behavior of a liposomal Vitamin C formulation developed by West Bengal Chemical Industries Ltd. (WBCIL) using non-genetically modified sunflower-derived phosphatidylcholine, with a focus on its potential as a topical alternative to conventional Vitamin C supplements. Methods: The liposomal formulation was synthesized and subjected to comprehensive characterization using advanced analytical techniques. High-Performance Liquid Chromatography (HPLC) was used to determine encapsulation efficiency. Fourier Transform Infrared Spectroscopy (FTIR) was employed to identify functional groups, while X-Ray Photoelectron Spectroscopy (XPS) confirmed elemental composition. Dynamic Light Scattering (DLS) was used to measure hydrodynamic particle size, zeta potential, and polydispersity index. Stability and sustained release of Vitamin C were evaluated under physiological and thermal conditions. Results: The formulation demonstrated a high encapsulation efficiency of 91.98%, with an average particle size of 184 nm. The zeta potential was -33.7 mV, indicating excellent electrostatic stability, while the polydispersity index (PDI) of 0.334 reflected uniform particle distribution. FTIR confirmed the presence of functional groups associated with Vitamin C and phosphatidylcholine, and XPS analysis detected the target elements on the surface of the liposomal Vitamin C. The formulation exhibited sustained release properties and maintained structural integrity under various conditions, suggesting good thermal and physiological stability. Conclusion: WBCIL’s liposomal Vitamin C formulation offers high encapsulation efficiency, nanoscale size, and excellent stability, making it a promising and bioavailable alternative to traditional Vitamin C supplements. Its potential for topical application enhances its value for skin health, particularly in promoting collagen synthesis and photoprotection.
Copyright (c) 2025 Poulami Gupta Banerjee, Atanuka Paul, Argha Chakraborty, Subrata Kundu http://creativecommons.org/licenses/by-nc-nd/4.0
The occurrence of bladder tumor among young age group in Tikrit city population 2025
Objectives: The research aimed to establish the frequency of bladder cancer among patients who were below forty years old in Tikrit Teaching Hospital and Salahdin General Hospital in Iraq. It dealt with epidemiological aspects of this disease, including gender predisposition, effects of essential risk factors, such as smoking and occupational exposure, and tumor recurrence. Methods: A retrospective study was conducted between 2016 and 2024 in Tikrit Teaching Hospital and Salahdin General Hospital. A total of 38 young patients diagnosed with bladder cancer were analyzed for demographic, clinical, and pathological details. Results: The study results indicated that most bladder cancer cases were in male patients in the working group between 30 and 39 years, as they constituted 52.7% of the entire sample population. The possible risk factors included smoking, with 63.2% of the patients involved, and occupational exposure, with 52.7%. The recurrence rate among the patients was high, especially among those diagnosed at an advanced stage. Conclusion: The results indicate the need to pay closer attention to early diagnosis and timely prevention in youth. Public health interventions should focus on targeting smoking control measures, occupational risk reduction, and awareness of early diagnosis.
Copyright (c) 2025 Mohanned Hussam Mohammed Saeed http://creativecommons.org/licenses/by-nc-nd/4.0
Impact of doing Medication Reconciliation at the start of Inpatient Admission for Acute Care
Medication reconciliation, conducted at the onset of inpatient admission for acute care, is a pivotal process aimed at averting medication errors and ensuring patient safety. This review scrutinizes the impact of medication reconciliation on patient outcomes, healthcare quality, and cost-effectiveness within acute care settings. While medication reconciliation entails creating an accurate list of a patient's current medications, comparing it with prescribed medications, and making clinical judgments, its efficacy has garnered increased attention from healthcare accrediting bodies such as the Accreditation Canada Program and the Joint Commission of the USA. Additionally, the World Health Organization's High 5s Project underscores its global significance in enhancing patient safety. Despite its benefits, medication reconciliation poses challenges such as inadequate patient medication documentation and resource limitations. Overcoming these challenges is pivotal to integrating medication reconciliation seamlessly into routine clinical practice. Nevertheless, the benefits of medication reconciliation in reducing medication errors, optimizing patient outcomes, and mitigating healthcare costs are substantial, highlighting the necessity of prioritizing its implementation in acute care settings.
Copyright (c) 2025 Parth Munjal, Yash Vardhan Trivedi, Mini Virmani, Vasu Gupta, Suryabir Singh Kamboj, Baltej Singh, Rohit Jain http://creativecommons.org/licenses/by-nc-nd/4.0
The Nexus of Mouthwash, Oral Dysbiosis, and Cardiovascular Health: A Review
The human oral cavity is home to a diverse microbial community consisting of bacteria, fungi, archaea, protozoa, and viruses that thrive on various surfaces. These bacteria influence oral hygiene and also play a vital role in cardiovascular homeostasis. Oral Hygiene has become one of the most important factors of overall health and a crucial determinant of social health. The mouthwash and oral hygiene market is estimated to include 202.58 million consumers in 2024. Regular use of mouthwashes has been shown to improve oral and dental hygiene; however, mouthwash-induced oral dysbiosis has become a concern. It is found to induce a proinflammatory state that promotes atherosclerosis, worsens insulin resistance and hypertension, and increases the risk of cardiovascular disease. The guidelines for determining the use of mouthwash that takes into account both the benefits and harm associated with its use are not clear and are a topic of further research. The complex interplay between oral dysbiosis, oral hygiene, and cardiovascular outcomes highlights the need for a comprehensive understanding of these relationships to improve oral and cardiovascular health. This review focuses on the pathophysiology of mouthwash-induced oral dysbiosis and cardiovascular function and discusses various evidence to compare the pros and cons of mouthwash usage.
Copyright (c) 2025 Mounika Nagarani Tunuguntla, Jill Bhavsar, Bhupinder Singh, FNU Anamika, Kanishk Aggarwal, Dilip Kumar Jayaraman, Rohit Jain http://creativecommons.org/licenses/by-nc-nd/4.0
The Impact of COVID-19 on Medical Training: An Observational Study from a University-Affiliated Health Network's Experience
Objective: An anonymous online survey was conducted at a university-affiliated health network to witness the impact of COVID-19 on Internal medicine residents and subspecialty fellows. Methods: This study involved a 28-question online survey for internal medicine residents and subspecialty fellows. Descriptive outcomes were provided for all respondents. We compared the impact of COVID-19 on training using a chi-square test for fellows versus residents, with a significance level of p < 0.05. Subgroup analyses and an open-ended question were also included. Results: The survey had a 67% response rate (52/78). Three-fourths of the respondents were residents (39/52), and the rest were fellows. Among all trainees, 33% (17/52) had <1 year of training left, with 59% (10/17) being residents. Overall, 82.7% (43/52) reported a "neutral or negative" impact on training, and 17.3% (9/52) reported a "positive or very positive" effect. 56% reported a decrease in procedures. In open-ended responses, 6 were positive, and 9 were negative. Conclusions: Our survey, consistent with current international literature, shows a negative impact on training due to changes in healthcare delivery during the pandemic. This led to a reduction in procedural opportunities and limited educational sessions. A follow-up study may help identify longer-lasting effects and areas for improvement.
Copyright (c) 2025 Nitasa Sahu, Dania Mosquera, Kanishk Aggarwal, Jill Stolzfus, Rohit Jain, Thomas Zanders, Douglas Corwin http://creativecommons.org/licenses/by-nc-nd/4.0
Relationship Between Neutrophil-to-Lymphocyte Ratio (NLR) and Sepsis and Mortality in Patients Admitted to the Emergency Department: A Retrospective Observational Study
Objective: This study aims to investigate the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the diagnosis of sepsis and in-hospital mortality in patients admitted to the emergency department. Methods: This was a retrospective observational study conducted at the Emergency Department of Esenyurt Necmi Kadıoğlu State Hospital. Data from adult patients who presented to the emergency department between January 1, 2023, and December 31, 2024, were analyzed. Patients with complete blood count (CBC) results and suspected or confirmed infection were included. NLR values were calculated and compared between patients with and without sepsis, as well as between survivors and non-survivors. Multivariate logistic regression and ROC curve analysis were used to assess the predictive value of NLR for sepsis and mortality. Results: A total of 500 patients were included. Of these, 28.8% had sepsis, and 13.8% died during hospitalization. The mean NLR was significantly higher in patients with sepsis (6.4 ± 3.2) than in those without (3.9 ± 2.1) (p < 0.001), and non-survivors (7.2 ± 3.5) compared to survivors (4.5 ± 2.4) (p < 0.001). NLR was found to be an independent predictor of both sepsis (OR: 1.85, 95% CI: 1.42–2.41) and mortality (OR: 2.12, 95% CI: 1.55–2.91). The optimal NLR cutoff was 5.1 for sepsis and 6.8 for mortality. The AUC for sepsis and mortality prediction was 0.78 and 0.81, respectively. Conclusion: NLR is a simple, fast, and cost-effective biomarker that can aid in the diagnosis of sepsis and the prediction of in-hospital mortality in emergency department patients. Its routine use in clinical practice could enhance early detection and risk stratification, particularly in resource-limited settings.
Copyright (c) 2025 Dr. Erkan Boğa http://creativecommons.org/licenses/by-nc-nd/4.0
Omega-3 Fatty Acids in Cardiovascular Health: Navigating the Duality of Benefits and Risks
Objective: Cardiovascular diseases (CVDs) remain the leading global cause of death and healthcare economic burden. Omega-3 fatty acids (FAs) have been widely advocated for their potential role in improving cardiovascular health, yet emerging evidence questions their efficacy across diverse CVD contexts. This narrative review evaluates the historical and current understanding of omega-3 FAs in CVD management, contrasting their purported benefits with contemporary evidence on risks and outcomes. Methods: We conducted a comprehensive synthesis of existing literature, including clinical trials, meta-analyses, and observational studies, to assess the role of omega-3 FAs in primary and secondary CVD prevention. Focus was placed on their effects on hypertension, atherosclerosis, ischemic heart disease, and overall morbidity/mortality. Results: Omega-3 FAs demonstrate clear benefits in secondary prevention of certain CVDs, particularly in reducing triglycerides and arrhythmia risk. However, recent studies highlight inconsistent outcomes regarding their impact on overall mortality, stroke prevention, and efficacy in diverse populations. While some trials reaffirm their anti-inflammatory and plaque-stabilizing properties, others suggest negligible effects or even potential risks (e.g., atrial fibrillation in high doses). Conclusion: The role of omega-3 FAs in CVD management is nuanced, with evidence supporting selective benefits but also underscoring limitations and unresolved controversies. Clinicians must weigh these findings against individual patient profiles. Further research is needed to clarify optimal dosing, formulations, and target populations to maximize therapeutic potential while mitigating risks.
Copyright (c) 2025 Priyanshi Shah, Twinkle Shah, Pathan Mayur Srinivas, Vasu Gupta, Namita Ruhela, Rohit Jain http://creativecommons.org/licenses/by-nc-nd/4.0
Long-Term Impact of Oral Contraceptive Use in Adult Life on Postmenopausal Hypertension
Oral contraceptive pills (OCP) are widely utilized globally for both contraceptive and non-contraceptive purposes, with combined oral contraceptive pills being the more commonly prescribed type compared to progestin-only pills. Despite their efficacy, OCPs are associated with various adverse effects, including the development of hypertension. Hypertension, a prevalent condition among older women, particularly those over 60 years of age, has been linked to prior OCP use, potentially contributing to an elevated risk of cardiovascular and cerebrovascular disorders. The mechanisms underlying OCP-induced hypertension include activation of the renin-angiotensin-aldosterone system (RAAS), endothelial dysfunction, vascular remodeling, inflammation, and oxidative stress. Evidence suggests that estrogen-containing OCPs can exert long-term effects on blood pressure regulation, increasing the likelihood of hypertension, particularly with prolonged use or higher estrogen doses. However, newer formulations with lower estrogen doses have been shown to mitigate this risk. Additionally, certain progestins, such as drospirenone, may exert protective effects by reducing blood pressure. Ongoing research and vigilant monitoring are essential to further elucidate these associations and optimize OCP formulations for safer use.
Copyright (c) 2025 Simran Dahiya , Tejal Mehta, Abhinav Malik, Ritish Bhuma, Mayank Dhalani, Srishty Agarwal, Yash Vardhan Trivedi, Rohit Jain http://creativecommons.org/licenses/by-nc-nd/4.0
IgG4-Related Disease: Insights into a Multisystem Inflammatory Disorder
IgG4-related disease is a multisystem inflammatory disease characterized by the accumulation of IgG4-positive plasma cells, storiform fibrosis, and obliterative phlebitis. Although it is often referred to as a disease of the pancreas, salivary glands, and kidneys, it occurs with the involvement of almost any organ, which makes the diagnosis very difficult. The reason is not well understood, but an abnormal immune response, particularly that involving helper T cells, regulatory T cells, and B cells, plays an important role. The diagnosis is usually made based on clinical, laboratory, and histopathological lines. Serum IgG4 levels are minimally supportive when determining a diagnosis, never definitively so, but for the most part. The traditional management starts with glucocorticoids, which have been proven to alleviate the condition; however, flare-ups occur frequently. Consequently, steroid-sparing agents like rituximab are becoming increasingly employed to treat the disease over the long term. This review highlights the contemporary aspects of research by relating IgG4-RD in the areas of epidemiology, underlying mechanisms, natural history, clinical factors, diagnostic difficulties, and therapeutic strategies. The ongoing research provides better insights on the possibility of other targeted therapies and standardized guidelines that would help improve the care of patients. The elucidation of this disorder is vital for the early diagnosis and treatment of patients to avert irreversible organ damage and improve the outcome.
Copyright (c) 2025 Pragati Chhikara, Jaykumar Jakasaniya http://creativecommons.org/licenses/by-nc-nd/4.0
From Ancient Wisdom to Modern Health: 'Let Food Be Thy Medicine' – Examining the Cardiovascular Impact of Ghee and Seed Oils"
Diet and eating habits are closely linked to overall health, particularly cardiovascular well-being. In recent years, there has been a growing trend in the consumption of ghee (clarified butter) and seed oils (vegetable oils derived from plant seeds such as corn, soybeans, sunflower, and peanuts). While concerns have been raised due to their high-fat content, both ghee and seed oils contain bioactive compounds with potential health benefits. Ghee is a rich source of fat-soluble vitamins—A, D, E, and K—and also contains short-chain and medium-chain fatty acids that may have anti-inflammatory and lipid-modulating effects. Some studies suggest that moderate ghee consumption may improve HDL levels and reduce LDL oxidation, potentially lowering the risk of atherosclerosis. Conversely, seed oils are high in Omega-6 and Omega-3 polyunsaturated fatty acids (PUFAs), which are known to support endothelial function and reduce systemic inflammation when consumed in appropriate ratios. This narrative review aims to assess and compare the effects of ghee and seed oil intake on cardiovascular disease risk, drawing on current scientific literature to clarify their respective roles in cardiovascular health and disease prevention.
Copyright (c) 2025 FNU Anamika, Sidharth Mahajan, Parth Munjal, Kanishk Aggarwal, Rohit Jain http://creativecommons.org/licenses/by-nc-nd/4.0