A Tiny Injection, a Big Save: Thrombin for Ruptured Femoral Pseudoaneurysm
Background: Femoral artery pseudoaneurysm is a well-recognized complication following diagnostic and therapeutic endovascular procedures. Although most pseudoaneurysms remain clinically stable, rupture is uncommon and may result in significant hemorrhage, rapid decline in hemoglobin, and hemodynamic compromise. Surgical repair has traditionally been considered the treatment of choice in ruptured cases; however, ultrasound-guided percutaneous thrombin injection has emerged as a minimally invasive alternative in selected patients. Case Presentation: A 73-year-old female presented with pain and bluish discoloration of the left lower limb. Computed tomography angiography demonstrated significant atherosclerotic disease with approximately 60–70% luminal narrowing of the left common iliac artery. The patient underwent successful left common iliac artery angioplasty with deployment of a 6 × 57 mm stent through left femoral arterial access. Three to four days after the procedure, she developed discoloration and swelling at the femoral access site associated with a substantial fall in hemoglobin from 11.6 g/dL to 6.4 g/dL. Ultrasonography of the left proximal thigh revealed a multilobulated pseudoaneurysm measuring approximately 1.2 × 2 cm arising from the common femoral artery with turbulent flow on color Doppler and an adjacent heterogeneous collection suggestive of a contained ruptured pseudoaneurysm. Considering the patient's advanced age and comorbidities, ultrasound-guided percutaneous thrombin injection was performed. Complete thrombosis of the pseudoaneurysm was achieved immediately, with no residual flow on follow-up ultrasonography. Conclusion: Ruptured femoral artery pseudoaneurysm is a rare but potentially life-threatening complication following endovascular intervention. This case highlights that ultrasound-guided percutaneous thrombin injection can be a safe, effective, and minimally invasive treatment option in carefully selected patients with contained rupture, potentially avoiding the need for surgical intervention.
Femoral Pseudoaneurysm, Thrombin Injection, Angioplasty, Vascular Complications, Endovascular Intervention, Ruptured Pseudoaneurysm.
Dr. Karnayina Pooja Harshitha, Dr. Harshita M. Sharda, Dr. Siddharth Shah
Towards Interpretable Alzheimer’s Disease Diagnosis: A Multi-Model Machine Learning Framework with Consensus Feature Selection and SHAP-Driven Explainability
Alzheimer’s disease (AD) is a progressive neurodegenerative disorder representing the leading cause of dementia worldwide. Timely and accurate diagnosis remains a persistent clinical challenge owing to symptom overlap, diagnostic subjectivity, and the inaccessibility of neuro imaging-dependent workflows in resource-limited settings. This study proposes a comprehensive and clinically interpretable machine learning framework for automated AD classification using structured tabular clinical data drawn from a publicly available dataset comprising 2,149 patient records characterised by 34 demographic, lifestyle, clinical, and cognitive features. The proposed pipeline encompasses systematic data cleaning, categorical encoding, StandardScaler-based normalisation, and Synthetic Minority Oversampling Technique (SMOTE) application to address class imbalance. A novel consensus-driven multi-criteria feature selection strategy was developed, integrating Random Forest importance, Recursive Feature Elimination, and SHAP-based ranking into a unified normalised scoring mechanism to identify the 15 most diagnostically discriminative features. Eight classifiers spanning baseline and advanced architectural tiers were subsequently trained, optimised via stratified cross-validation, and evaluated across six performance metrics. LightGBM achieved the highest overall performance, attaining an accuracy of 94.88%, F1-Score of 92.62%, Cohen’s Kappa of 0.8871, and AUCROC of 0.9491. Statistical validation through 10-fold cross-validation and Wilcoxon signed-rank testing confirmed the superiority of gradientboosting ensemble models over baseline classifiers at the p < 0.05 significance level. Based on explainability analysis, further clinically meaningful feature attribution, and enhanced model transparency and interpretability. The proposed framework demonstrates strong diagnostic potential and offers a scalable, cost-effective, and interpretable alternative to imaging-dependent AD diagnostic pipelines.
Alzheimer’s Disease; Machine Learning; Explainable Artificial Intelligence; Feature Selection; Lightgbm; Shap; Clinical Decision Support; Ensemble Learning.
Fatima Tauseef, Ahmad Jamal, Fahad Naseer, Md Shafayet Hossain, Dr. Mahzabin Mahmud
Incidence of Sural Nerve Injury following Endovenous Laser Ablation of the Short Saphenous Vein: A Prospective Observational Study
Background: Endovenous laser ablation (EVLA) is now the treatment of choice for symptomatic short saphenous vein (SSV) reflux, but the close anatomical relationship between the SSV and the sural nerve places the nerve at risk of thermal injury. Reported rates of post-operative paraesthesia vary widely, and the natural history of nerve recovery is poorly characterised in prospective cohorts. Materials and Methods: In this prospective observational study, 50 consecutive adult patients undergoing 1470-nm radial-fibre EVLA for symptomatic SSV reflux (with or without saphenopopliteal junction incompetence) at a tertiary-care teaching hospital were followed for 3 months. CEAP classification, vein diameter and delivered laser energy were recorded. Patients were assessed for numbness, tingling and burning pain along the sural nerve distribution at post-operative day (POD) 0, POD 1, 1 week, 1 month and 3 months; symptoms persisting beyond 1 month were further evaluated with nerve conduction studies (NCS). Associations between sural nerve injury and age, sex and CEAP subclass were analysed using Fisher's exact test. Results: Mean age was 45.7 ± 11.6 years (range 18–79) with a male predominance (72%). Mean SSV diameter was 3.66 ± 0.83 mm and mean energy delivered was 1171.4 ± 124.8 J. Sural nerve symptoms occurred in 5/50 patients (10%; 95% CI 4.3–21.4%), most commonly numbness (6%) and burning pain (4%) at POD 1 and 1 week. Symptoms resolved completely within 1 month in 4 of 5 patients; 1 patient (2%) had persistent injury confirmed on NCS at 3 months. No significant association was found between injury and age, sex, or CEAP classification (all p>0.05), though injury rates were numerically higher in C4 disease. Conclusion: EVLA of the SSV, performed with energy titration and generous ultrasound-guided tumescent anaesthesia, carries a modest and largely self-limiting risk of sural nerve injury, with the great majority of cases resolving within 1 month on conservative management.
Varicose veins; Endovenous laser ablation; Short saphenous vein; Sural nerve injury; CEAP classification; Nerve conduction study.
Dr Rajesh G Patil, Dr Preksha Sharma, Dr Aditya Salian
Urinary Volatile Organic Compounds As Early Diagnostic Biomarkers For Prostate Cancer In Obese Men Using Artificial Intelligence
Background: Prostate cancer is one of the most frequent types of malignancy in men across the globe, and early diagnosis has not been easy, especially in obese men. There are also metabolic changes linked to obesity that have the potential to alter the biology of prostate cancer, as well as lowering the accuracy of standard prostate cancer markers like prostate-specific antigen (PSA). The urinary volatile organic compounds (VOCs) are promising candidates for non-invasive biomarkers since such compounds can indicate underlying metabolic and pathological alterations. Objective: The paper was designed to assess the methodological and statistical viability of exploring urinary volatile organic compounds as an early diagnostic biomarker of prostate cancer in men with obesity using artificial intelligence-based predictive models. Methods: The plastic cross-sectional analytical study of the treatment of obese men was performed with participants aged 50 years and older. The data on demographics, anthropometrics, and clinical data were gathered through a structured questionnaire. The Shapiro-Wilk test was used to check the normality of the continuous variables. The reliability was tested based on the alpha of Cronbach, whereas construct validity was tested based on the Kaiser- Meyer-Olkin (KMO) measure and Bartlett test of sphericity. Independent Samples t-test, one-way ANOVA, Kruskal-Wallis test, and Chi-square test of independence were also done as part of inferential analyses. The methods used were Pearson correlation and multiple linear regression analysis to determine the relationship between variables and to predict them. Artificial intelligence-based predictive modeling was applied to integrate urinary VOCs with clinical and anthropometric variables to assess their diagnostic performance for early prostate cancer detection. Results: Normality analysis revealed that there had been mixed patterns of distribution, and therefore both parametric and non-parametric tests were used. The urinary symptom severity scale was found to have high reliability (Cronbach's 0.80) and fair construct validity (KMO 0.60; Bartlett test p < 0.001). Statistically significant differences and changes were indicated in the inferential analyses according to major clinical and anthropometric variables. There was a strong relationship that was found between prostate cancer status and PSA levels. Correlation was found to be positive between age, height, weight, and BMI, and the regression analysis identified height and BMI as the positive predictors of body weight. The artificial intelligence model demonstrated promising performance in identifying patients at higher risk of prostate cancer based on urinary VOCs and clinical variables. Conclusion: The results prove that the data and the analysis system are sound, valid, and statistically strong to explore urinary VOCs as the initial diagnostic biomarkers of prostate cancer in obese men. The research confirms the fact that the possible use of incorporating artificial intelligence-assisted urinary-based non-invasive biomarkers in conjunction with clinical parameters could enhance early detection methods. Secondary research that includes direct VOC profiling and longitudinal designs will be channeled in the future to ascertain the accuracy of diagnosis and clinical applicability.
Artificial Intelligence; Prostate cancer; Obesity; Urinary volatile organic compounds; biomarkers; early diagnosis; PSA..
Nure Alam Howlader, Md Rokibul Hasan, Mohammad Delowar Hossain Gazi, Daniel Benniah John, Imama Tabussum Owishe, Aktaruzzaman Azad, Sonya Ghosh, Sanjida Alam Eshra, Aslesha Changalasetty, Sharmin Akter
Cardiometabolic Effects of Yoga Practice Under Variable Thermal Stress: A Study on Body Weight and Total Cholesterol
In the current situation the average cases of Dyslipidaemia and cardiovascular diseases are rapidly increasing in the public. In this study we aimed to investigate the comparative effect of temperature yoga program on Total Cholesterol and Body weight among patients having dyslipidaemia and BMI over 25. A total of Ninety male having these criteria were included in this 3-armed randomized trial and allocated randomly to Hot yoga group 1 (n = 30) with 55-60 min yoga sessions for a duration of 12 weeks, Normal temperature yoga group 2 (n = 30) with 55-60 min yoga sessions for a duration of 12 weeks and the cold temperature yoga group 3 (n = 30) for the same duration. The hot yoga group was given intervention in 35 to 45 degrees, normal was 23 to 27 and the cold temperature yoga was 5 to 15 degrees. The yoga protocol remained same and of equal intensity for the all three groups. After 12 weeks, A significant difference was observed in the body weight, p < .001)., but in case of total cholesterol there was no significant difference between the Hot temperature, Normal Room Temp. and Cold Temp. groups. The independent variable, Group temperature, did not show a statistically significant effect on post-test of total cholesterol, p = .762). This suggests that differences in temperature conditions (hot, cold, and room) did not meaningfully influence. These findings suggest that temperature effectively reduces the Total Cholesterol, not statistically significant but improves the health parameter and in case of weight significant effect of temperature was found among the three groups.
Artificial Intelligence-Driven Early Detection of Neurological Disorders and Its Implications for Personalized Rehabilitation Strategies
Early AD stratification is clinically relevant, and both structural MRI and cognitive–biomarker profiles contain complementary diagnostic information. We offer NeuroFusionAI, an ImageNet pre-trained ViT-Small/16 MRI branch (to extract relevant brain feature representation signals), combined with an FT-Transformer clinical branch via a bidirectional cross-attention module, and validate it on a four-class AD-stage task (NonDemented, VeryMildDemented, MildDemented, ModerateDemented). An important limitation is acknowledged: the imaging and clinical data are not sampled from the same patient cohort. The MRI set consists of 28,160 public access 2D brain images, while the clinical set is purely synthetic (6,000 records - 1,500/class) and is matched to images only at the level of diagnostic class, but never at the level of subject. It makes no claim of true multimodal correspondence per patient. One of the features (global CDR) was removed from consideration as a deterministic label proxy to avoid leakage. We circumvent optimistic bias from multiply-augmented near-duplicates with a perceptual-hash grouping procedure, which commits each near-duplicate group to exactly one data split. NeuroFusionAI achieves 98.18% accuracy and 0.9724 macro-F1 in under 5-fold stratified-group cross-validation with a held-out test set. Importantly, feature-concatenation fusion (0.9761) and a clinical-only XGBoost baseline (0.9770) equal or slightly outperform cross-attention fusion; differences between models are not statistically significant (Wilcoxon, n=5 folds). We view these results with skepticism; clinical-only performance near-ceiling is an expected byproduct of class-conditional synthetic generation, not evidence that clinical features alone will satisfy in real-world practice. Grouping and pairing tables available for full transparency.
Alzheimer’s disease; multimodal fusion; vision transformer; FT-Transformer; cross-attention; data leakage; synthetic clinical data; explainable AI..
Tofayel Ahmed Onik, Kamrun Naher Irin, Md Noman Azam, Kabita Shamia Akter, Mahbub Ahmed Nabil, Iftekhar Hossain, Sonia Akter
AI-Driven Early Detection of Chronic Kidney Disease: A Comparative Benchmark of Ensemble Learning Models with Clinical Explainability
Chronic kidney disease (CKD) is an emerging global health burden, and a significant volume of recent machine-learning research reports automated detection with near-perfect accuracy; in fact, many studies claim 96 100% accuracy on benchmark datasets. These results deserve further examination, however, because CKD is itself classified according to the estimated glomerular filtration rate (GFR) when GFR or a GFR-derived variable is a feature of the model input, a classifier can imitate the labeling rule rather than learn an actual diagnostic signal. We perform a controlled comparative benchmark of thirteen classifiers (five conventional baselines and eight ensemble learners) on a staged CKD dataset comprising 4,000 records, under two prediction framings (six-class stage classification and balanced binary early-vs-progressed formulation) in a rigorous, leakage-controlled protocol using stratified ten-fold cross-validation. To explicitly measure the impact of label leakage, we performed an ablation analysis where GFR and cluster variables are alternately removed. In the presence of these variables, ensemble models achieve 97.8% accuracy and a Matthews correlation coefficient (=1) > 0.97; upon their removal, every single model (including gradient-boosted ensembles) collapses to chance-level performance (multiclass accuracy 21.9%, below the baseline of majority class at 25.1%; binary Matthews correlation coefficient ≈0 with all models collapsing to defaulting on majority class). Indeed, the absence of a learnable signal is confirmed by SHAP and LIME analyses, where near-zero feature attributions are observed. The pairwise Wilcoxon signed-rank tests do not indicate any statistically significant differences between the leading models. We show that the state-of-the-art headline accuracies reported for CKD detection are in fact, on this dataset, an artefact of label leakage, and that the clinical and lifestyle features which remain carry no reliable predictive information about CKD stage. We suggest that auditing leakage, establishing proper baselines and validation on real-world clinical cohorts as preconditions for trustworthy CKD prediction models and release our entire protocol to encourage reproducible, plain sight benchmarking.
Chronic kidney disease; machine learning; ensemble learning; data leakage; explainable artificial intelligence; SHAP; benchmarking; clinical decision support.
Kabita Shamia Akter, Tofayel Ahmed Onik, Mohammad Yasin, Mahbub Ahmed Nabil, Iftekhar Hossain, Sonia Akter
Predictors of Prolonged Intensive Care Unit Stay After Major Neurosurgical Procedures
Background: Major neurosurgical procedures often require postoperative intensive care unit (ICU) admission for neurological monitoring and organ support. Prolonged ICU stay is associated with increased morbidity, healthcare costs, and limited ICU bed availability. Identifying factors associated with extended ICU admission may improve perioperative planning and optimize resource utilization. Objective: To determine the clinical and perioperative predictors of prolonged ICU stay among patients undergoing major neurosurgical procedures. Methods: A retrospective study was conducted on 100 patients who underwent major neurosurgical procedures at a tertiary care hospital between January 2024 and June 2024. Demographic, clinical, operative, and postoperative data were retrieved from medical records. Prolonged ICU stay was defined as an admission lasting more than 72 hours. Variables including age, sex, Glasgow Coma Scale (GCS), American Society of Anesthesiologists (ASA) status, emergency surgery, operative duration, intraoperative blood loss, postoperative mechanical ventilation, and complications were analyzed using univariate and multivariate logistic regression. Statistical analysis was performed using SPSS version 27.0, with a p-value <0.05 considered statistically significant. Results: Of the 100 patients, 58% were male, and 42% were female, with a mean age of 49.8 ± 15.6 years. Prolonged ICU stay occurred in 36 patients (36%). Patients with prolonged ICU stay were significantly older than those with shorter stays (56.3 ± 14.2 vs. 46.1 ± 15.3 years; p=0.003). Emergency surgery (61.1% vs. 31.3%; p=0.006), preoperative GCS ≤8 (50.0% vs. 18.8%; p=0.001), operative duration >4 hours (p=0.012), blood loss >500 mL (p=0.021), postoperative mechanical ventilation >24 hours (p<0.001), and postoperative complications (p=0.004) were significantly associated with prolonged ICU stay. Multivariate analysis identified postoperative mechanical ventilation (adjusted OR=4.72, 95% CI: 2.01–11.08; p<0.001), low preoperative GCS (adjusted OR=3.15, 95% CI: 1.34–7.42; p=0.008), and advanced age (adjusted OR=1.04, 95% CI: 1.01–1.08; p=0.018) as independent predictors. Conclusion: Advanced age, poor preoperative neurological status, prolonged postoperative mechanical ventilation, emergency surgery, increased operative duration, and postoperative complications independently predicted prolonged ICU stay following major neurosurgical procedures. Early recognition of these risk factors may facilitate risk stratification, optimize ICU resource allocation, and improve postoperative outcomes.
Neurosurgery; Intensive Care Unit; Predictors; Length of Stay
Baynazir Khan, Fatima Khan, Abdul Mannan, Abdul Aziz Khan, Gul Mohammad
Functional Outcomes After Lumbar Microdiscectomy for Lumbar Disc Herniation: A Single-Center Experience
Background: A herniated disc in the lower back is one of the most common sources of pain and radiculopathy, and can seriously limit a patient's function and quality of life. For patients with chronic pain who do not respond to conservative pain relief, the most common surgical procedure is lumbar microdiscectomy. This study aimed to assess the functional outcome after lumbar microdiscectomy for lumbar disc herniation. Objective: To evaluate functional outcomes after lumbar microdiscectomy and to determine factors associated with better recovery. Methods: A retrospective study was conducted on 100 patients who underwent lumbar microdiscectomy for symptomatic lumbar disc herniation between January 2023 and December 2024. The demographic, clinical, radiological, and operative information was retrieved from the medical records. Functional outcome was assessed using the Oswestry Disability Index (ODI) and the Visual Analog Scale (VAS) preoperatively and at 6 months after surgery. The data were analyzed using SPSS version 27. The continuous variables were presented as mean ± standard deviation, and categorical variables were represented by frequency and percentages. A p-value <0.05 was considered statistically significant. Results: The study included 62 males and 38 females, with a mean age of 44.8 ± 11.2 years. The L4–L5 level was the most frequently affected (54%), followed by L5–S1 (36%). Mean ODI significantly improved from 56.4 ± 12.7 preoperatively to 18.9 ± 9.3 postoperatively (p < 0.001), while mean VAS scores decreased from 8.2 ± 1.1 to 2.1 ± 1.3 (p < 0.001). Good-to-excellent functional recovery was achieved in 87% of patients. Younger age (<50 years) (p = 0.028) and symptom duration <6 months (p = 0.015) were significantly associated with better outcomes. Overall complication rate was 6%, with no procedure-related mortality. Conclusion: Lumbar microdiscectomy is an effective and safe surgery with a high degree of pain relief and function improvement for patients with lumbar disc herniation. Postoperative recovery was better for those who underwent early surgery and those who were younger.
Lumbar microdiscectomy; Lumbar disc herniation; Functional outcomes; Oswestry Disability Index.
Baynazir Khan, Saad Sultan, Attiya Nasir, Faiz Alam
Comparison of Early Postoperative Complications between On-Pump and Off-Pump Coronary Artery Bypass Grafting
Background: Coronary artery bypass grafting (CABG) remains one of the finest surgical techniques for treating severe coronary artery disease. Traditional on pump CABG is still widely in use but off-pump CABG has gained popularity as a substitute method to reduce the side effects of cardiopulmonary bypass. The superiority of either strategy in terms of clinical results and postoperative complications, however, is still up for debate. Aim of the Study: To assess the prevalence and predictors of early postoperative complications in patients receiving on-pump versus off-pump CABG. Patients and Methods: This prospective observational cohort study was conducted at the Cardiothoracic Surgery Department, National Heart Institute, Cairo, Egypt, and Shebein Elkom Teaching Hospital, Shebein Elkom, Menoufia, Egypt on 120 patients receiving isolated CABG who were divided equally into two groups: the off-pump CABG group and the on-pump CABG group. Results: On-pump CABG was related with prolonged operating time, mechanical ventilation, ICU and hospital stay. The unadjusted rate of patients with at least 1 postoperative complication was greater in the on-pump group. There were no statistically significant between-group differences in postoperative atrial fibrillation, myocardial infarction, stroke or transient ischaemic attack, acute renal injury, bleeding necessitating re-exploration, or 30-day mortality. Conclusion: Off-pump CABG was associated with shorter mechanical ventilation duration, ICU stay, and hospital stay and with a lower unadjusted incidence of the composite outcome of any early postoperative complication. However, the two techniques showed no statistically significant differences in individual major complications or 30-day mortality.
Coronary artery bypass grafting; On-pump CABG; Off-pump CABG; Cardiopulmonary bypass; Post-operative problems.
Mohamed Abdallah, Mohamed B.M. Abd Elbaki, M. A. Abouzaid, Ahmed Hassan Zaid, Mohamed R Badran, Shymaa Mamdouh Mohamed Abdu, Eslam Elshafey, Yosry M Thakeb
Condylar Remodeling and Relapse Patterns in Skeletal Class II High-Angle Patients Following Bimaxillary Surgery with Rigid Internal Fixation
Background and Objective: Skeletal Class II high-angle patients undergoing bimaxillary orthognathic surgery present a uniquely challenging biomechanical environment characterised by hyperdivergent mandibular growth, steep occlusal plane inclination, and inherent susceptibility to progressive condylar resorption. Rigid internal fixation (RIF) has largely supplanted wire osteosynthesis in contemporary practice; however, its differential influence on condylar remodelling morphology and long-term skeletal relapse in this specific phenotype remains incompletely elucidated. This prospective cohort study evaluated condylar remodelling patterns, three-dimensional skeletal stability, temporomandibular joint (TMJ) outcomes, and patient-reported quality of life over 36 months following bimaxillary surgery with rigid internal fixation versus conventional wire osteosynthesis in skeletal Class II hyperdivergent patients. Methods: One hundred and eight skeletally mature patients meeting strict inclusion criteria for skeletal Class II malocclusion with Frankfort-Mandibular Plane Angle (FMA) > 30° were prospectively recruited at a quaternary craniofacial unit (Noora Hospital Srinagar) between January 2021 and December 2022. Participants were allocated to RIF (n=56) or wire osteosynthesis control (n=52) groups based on surgeon assessment and patient preference. Cone-beam computed tomography (CBCT) was performed at six standardised time points over 36 months. Three-dimensional condylar morphometric analysis and cephalometric superimposition were conducted using Mimics Innovation Suite v26.0. Primary outcomes included condylar remodelling index (CRI), 3D skeletal relapse vectors, and percentage of planned surgical movement retained. Secondary outcomes included TMJ symptom scores, patient-reported VAS outcomes, and complication rates. Results: At 36 months, the RIF group demonstrated significantly lower total 3D skeletal relapse (2.1 ± 0.7 mm vs. 4.0 ± 1.3 mm; p < 0.001), superior retention of planned surgical movement (71.8 ± 6.2% vs. 52.6 ± 8.8%; p < 0.001), and substantially lower condylar remodelling index (4.4 ± 1.4 mm² vs. 8.6 ± 2.7 mm²; p < 0.001). Adaptive condylar remodelling was observed in 68.0% of RIF condyles versus 41.0% of control condyles (p < 0.001). Condylar resorption occurred in 22.0% versus 39.0% of condyles (p = 0.021). TMJ pain VAS scores improved significantly in both groups but were markedly better in the RIF cohort at 36 months (1.2 ± 0.6 vs. 2.8 ± 1.1; p = 0.001). Stable occlusal outcomes were achieved in 69.6% of RIF patients versus 44.2% of controls (p = 0.012). Overall complication rates were lower in the RIF group (10.7% vs. 21.2%; p = 0.039). Conclusion: Rigid internal fixation in bimaxillary surgery for Class II high-angle patients confers significantly superior condylar stability, reduced skeletal relapse, higher rates of adaptive remodelling, and improved patient-reported outcomes at 36 months compared to wire osteosynthesis. Virtual surgical planning with CAD/CAM-fabricated occlusal splints and precise intraoperative condylar positioning are critical determinants of postoperative TMJ health and long-term skeletal stability in this biomechanically high-risk patient cohort.
Skeletal Class II; high-angle malocclusion; bimaxillary surgery; rigid internal fixation; condylar remodelling; condylar resorption; orthognathic surgery; CBCT; three-dimensional cephalometry; temporomandibular joint.
Dr Mohammad Abrar Bhat, Dr Altaf Hussain Malik
Cutaneous Vasculitis in Autoimmune Rheumatic Diseases: Clinical Clues, Vascular Pathogenesis and Management
Background: Cutaneous vasculitis is an important clinical presentation of autoimmune rheumatic diseases, which can be an indication of systemic immune dysregulation. It tends to manifest itself in cases of Systemic Lupus Erythematosus, Rheumatoid Arthritis and other connective tissue disorders. Small-scale organised data on clinical presentation, vascular pathogenesis and clinical management outcomes are important clinically, but have not been supported to date in a single analytical model. The following paper will address clinical clues, vascular processes and reaction tendency of cutaneous vasculitis of autoimmune rheumatic disorders. Objective: The main aim of this research was to examine the connection between clinical presentation, vascular inflammatory process and treatment outcomes in autoimmune rheumatic disease-related endogenous cutaneous vasculitis patients. The study was also to establish the demographic factors which influence the severity and response to treatment of the disease. Methods: A cross-sectional study design was used as a quantitative study. A cohort of respondents with autoimmune rheumatic diseases who had either or both cutaneous and non-cutaneous vasculitis was recruited into the study and gave their data (n=221). It was a structured questionnaire, which took the form of a 5-point Likert scale; however, the questionnaire contained four broad domains, namely clinical clues, vascular pathogenesis, management practices and awareness. Demographic factors were age, gender, education, occupation, disease duration and type of diagnosis. Descriptive and inferential statistics were used to conduct the statistical analysis. Shapiro- WIlk test assisted in running the test of normality. Reliability was ascertained on Cronbach's alpha and Bartlett's Test, whereas the validity was ascertained on KMO. To establish relationships and predictive associations between variables, inferential statistics such as Independent Samples t-test, One-way ANOVA, Kruskal-Wallis test, Chi-Square test, Pearson correlation and regression analysis were used. Results: Findings revealed that all the variables were normally distributed (approximately) and hence, parametric tests could be conducted. The internal consistency was noted to be excellent as Cronbach's alpha was between 0.88 and 0.94. Its validity was proved by the test of adequate sampling (KMO = 0.89, p < 0.001); thus, it can be applied to a multivariate analysis. The inferences revealed that the performance in terms of clinical and management was very diverse among the genders, age groups, and the categories of diagnostic identities. Correlation analysis showed great positive correlations existing between clinical clues, pathogenesis, management and awareness. The most interesting correlation was a potential relationship between management and overall disease score, which implies that there is a positive relationship between the effectiveness of treatment and the condition of patients. The regression analysis revealed that the clinical clues, the pathogenesis and awareness were the significant predictors of the management outcomes, as they revealed a substantial portion of the variance. The clinical clues turned out to be the strongest predictor, which shows the importance of early symptom identification as one of the means to rectify the situation with a disease. Conclusion: The paper finds that cutaneous vasculitis is one of the important clinical signs of disease activity in autoimmune rheumatic diseases. Vascular inflammation, patient awareness and clinical presentation are intertwined with one another and influence the outcome of the treatment dramatically. It is important to note that early diagnosis and early intervention can enhance the prognosis and help to avoid complications. One aspect that the authors emphasise is that the method of clinical evaluation and patient-based management of autoimmune rheumatic disorders should also be evaluated, which, in turn, depends on the combination of various methods and techniques of combinatorics.
Cutaneous vasculitis, autoimmune rheumatic diseases, vascular pathogenesis, clinical clues, autoimmune diseases, systemic lupus, rheumatoid arthritis, management outcomes, inflammation, autoimmune disorders, regression analysis..
Dorina Ruci, Entela Shkodrani, Artur Zoto
Endothelial Dysfunction and Accelerated Atherosclerosis in Psoriasis and Psoriatic Arthritis: Bridging Dermatology, Rheumatology, and Vascular Medicine
Background: Chronic inflammatory diseases such as Psoriasis and Psoriatic Arthritis are also being recognized as systemic diseases and not those that are limited to the skin and joints. The already growing amount of evidence indicates that the illnesses are comorbid with the issues of cardiovascular complications, i.e., endothelial dysfunction of the endothelium and a timely atherosclerosis. Extensive systemic inflammation, disrupted metabolism, and lifestyle-related risk factors are some of the factors contributing to vascular damage, leading to increased morbidity and mortality. Although the severity of the disease, metabolic factors, and cardiovascular risks were raised, the exact correlation of the disease severity and the metabolic factors with cardiovascular risks has yet to be optimally studied in most of the clinical populations. Hence, the research was conducted in order to formulate the connections between psoriasis and psoriatic arthritis as well as endothelial dysfunction in the domains of dermatology, rheumatology, and vascular medicine. Objective: The main aim of the research was to evaluate the linkage between the severity of inflammatory diseases in both psoriasis and psoriatic arthritis and the risk of endothelial dysfunction and increased atherosclerosis. The secondary findings of the research were the assessments of the impact of metabolic (BMI, hypertension, diabetes) and lifestyle (smoking, physical activity, diet) factors and cardiovascular awareness. Methods: The design of the study article was the cross-sectional type, which was carried out in the outpatient department of dermatology as well as rheumatology in tertiary care hospitals. The purposive sampling method was employed to ensure that the respondents were 215 in number, made up of psoriatic arthritis and/or psoriasis. The data were collected in the form of a structured questionnaire, where the data were gathered as demographic variables, disease characteristics, metabolic risk factors, and behaviors related to cardiovascular health. The Likert-scale questions were used to measure the knowledge, lifestyle behavior, and symptoms regarding the vascular malfunction. The statistical analysis involved descriptive statistics, tests of normality, reliability analysis (Cronbach's alpha), validity tests (KMO and Bartlett test), and inferential tests, which included independent samples t-test, one-way ANOVA, Chi-square test of independence, Pearson correlation, and multiple regression analysis. Results: The results obtained revealed that most of the variables were normally distributed, meaning that there was an opportunity to use the tests that are parametric. The results of the reliability analysis show high internal consistency of the constructs of the questionnaire with a high level of Cronbach's alpha (over 0.80). Construct validity was validated through running a test of Bartlett (p < 0.05), and construct validity based on the use of a KMO (>0.80) and sampling adequacy was verified. The inferential analysis showed that the level of diseases was high in the demographic and lifestyle group, which had statistically significant differences between the interviewees' metabolic risk factors. A high prevalence of psoriasis and the severity of psoriatic arthritis were also noted to be significantly related to physical inactivity, obesity, and smoking. The chi-square analysis revealed that lipid disorders and hypertension were significantly related to diabetes cases in the scenario of smoking. The outcomes of the correlation study indicated weak and moderate positive correlations between the body surface area, which is modified by psoriasis, and cardiovascular awareness and severity of psoriasis. The severity of psoriasis, the severity of psoriatic arthritis, the body mass index (BMI), the joint involvement, as well as the symptoms of circulation were all significantly positively predictive risks of endothelial dysfunction. Both the hypothesis of the inflammatory burden and the vascular pathology hypothesis were proved to be true using the regression model, and found that it had a substantial percentage of cardiovascular risk variables forecasted by itself. Conclusion: They conclude from the study that psoriasis and psoriatic arthritis are directly related to cardiovascular risks due to permanent chronic systemic inflammation, and the disruption of metabolism and lifestyle changes. The interactive mechanism of inflammatory illness to the endothelium dysfunctions contributes to the cognitive activities of higher atherosclerosis in patients. Early detection of the risk factors and the ways of managing them is necessary in conjunction with the involvement of dermatologists, rheumatologists, and the representatives of the cardiovascular sources to minimize the number of complications in the long-run.
Psoriasis: Psoriatic Arthritis; Endothelial Dysfunction; Atherosclerosis; Systemic Inflammation; Cardiovascular risk; Metabolic syndrome, Inflammatory diseases; Regression Analysis; Cross-sectional study.
Entela Shkodrani, Dorina Ruci, Artur Zoto
Healing Outcomes and Predictors of Postoperative Sternal Wound Infections via Median Sternotomy Following Cardiac Surgery: A Comparative Retrospective Case-Control Study
Background: Surgical wound infection (SWI) following cardiac surgery via median sternotomy remains a serious complication associated with significant morbidity, prolonged hospitalisation, and increased healthcare costs. Mediastinitis and superficial sternal wound infections represent a spectrum of postoperative complications that adversely affect patient outcomes. Aim of the Study: This study aimed to assess the healing outcomes and predictors of mediastinitis and superficial sternal wound infections after cardiac surgery. Patients and Methods: This retrospective case-control study was conducted at the Cardiothoracic Surgery Departments of Shebein Elkom Teaching Hospital and National Heart Institute. A total of 100 adult patients who underwent cardiac surgery via median sternotomy were enrolled and divided into two groups: Group I (SWI group, n = 50) comprising patients who developed surgical wound infection, and Group II (Non-SWI group, n = 50) comprising patients who did not develop SWI. Results: Patients in the SWI group were significantly older and had higher body mass index compared to the non-SWI group. Diabetes mellitus was significantly more prevalent in the SWI group. SWI group had significantly lower preoperative hemoglobin and albumin and significantly higher white blood cell count and serum creatinine. The SWI group had significantly longer operation time, cardiopulmonary bypass time, duration of mechanical ventilation, ICU stay and total hospital stay. Postoperative mediastinitis occurred in 30.0% of SWI patients, wound dehiscence in 56.0%, clinical erythema in 86.0%, and clinical discharge in 86.0%. All SWI patients had positive wound cultures; the most frequently isolated organisms were coagulase-negative staphylococci (26.0%) and methicillin-sensitive Staphylococcus aureus (26.0%), followed by Pseudomonas aeruginosa (16.0%) and mixed bacterial flora (14.0%). All patients received antibiotics; management included regular dressing (80.0%), surgical debridement (42.0%), negative pressure wound therapy (38.0%), and muscle flap reconstruction (6.0%). The mean time to SWI diagnosis was 13.14 ± 6.08 days postoperatively, with 70.0% classified as superficial infections and 90.0% achieving complete healing within 90 days. Multivariate logistic regression identified body mass index (p = 0.006), diabetes mellitus (p = 0.007), preoperative albumin (p = 0.002), and operation duration (p = 0.001) as independent predictors of SWI. Conclusion: Surgical wound infection after cardiac surgery via median sternotomy is associated with significant patient morbidity and prolonged recovery. Higher body mass index, diabetes mellitus, preoperative hypoalbuminaemia, and prolonged operation duration are independent predictors of SWI. Preoperative optimisation of nutritional status, glycaemic control, and meticulous intraoperative time management are essential preventive strategies.
Surgical wound infection; mediastinitis; cardiac surgery; median sternotomy; risk factors; predictors; cardiopulmonary bypass..
Mohamed Abdallah, Sarah Mubarak Ibrahim, Mohamed B.M. Abd Elbaki, Shymaa Mamdouh Mohamed Abdu, Eslam Elshafey, Ramadan Ibrahim Mohamed Ibrahim Auf
Aetiological Spectrum and Predictors of Mortality in Hospitalised Adults with Community-Acquired Pneumonia: A Cross-Sectional Observational Study at a Tertiary Care Hospital
Background: Pneumonia is one of the major causes of morbidity and mortality due to infection worldwide and is known as community-acquired pneumonia (CAP). The aetiological spectrum of CAP in Indian tertiary care hospitals is different from Western countries, Klebsiella pneumoniae was predominant and high percentage of antibiotic-resistant pathogens. Empirical antibiotic guidance is dependent upon knowledge of local microbiology and mortality predictors. Methods: This was a cross sectional observational study involving 250 hospitalised adults with CAP (IDSA/ATS 2019 criteria) at a tertiary care hospital in 12 months. Comprehensive microbiological sampling, CURB-65 and PSI scoring, treatment outcome documentation, and multivariable mortality analysis were performed. Results: A causative pathogen was identified in 47.2% of cases. Streptococcus pneumoniae was most common (22.0%), followed by Klebsiella pneumoniae (14.0%), atypicals (8.0%), and viral co-infection (11.0%). Severe CAP (CURB-65 ≥3) was present in 22.4%; ICU admission in 18.0%; 30-day in-hospital mortality 9.2%. Independent mortality predictors included septic shock (aOR 5.6), CURB-65 ≥3 (aOR 4.5), inappropriate empirical antibiotic therapy (aOR 2.7), and diabetes (aOR 1.8). Conclusion: The CAP pathogen spectrum in this Indian tertiary care hospital combines classical pneumococcal disease with significant Gram-negative and atypical pathogen contribution. Inappropriate empirical therapy is a major modifiable mortality predictor. Local antibiogram-guided empirical protocols and early severity stratification by CURB-65 are essential for improving outcomes.
Community-acquired pneumonia; CAP; CURB-65; Streptococcus pneumoniae; Klebsiella pneumoniae; atypical pathogens; empirical antibiotic therapy; 30-day mortality; India.
Dr. VVSDS Ratnasagar, Dr. P Prudhvi Chandra
Clinical-Operative Outcomes of Laparoscopic Versus Open Appendicectomy in Adults with Complicated and Uncomplicated Acute Appendicitis: A Cross-Sectional Observational Study at a Tertiary Care Hospital
Background: The laparoscopic appendicectomy (LA) is the preferred method of dealing with uncomplicated acute appendicitis in high-income nations, whereas a comparison of its outcomes with surgical appendicectomy (SA) is scarce in the Indian tertiary care setting, especially with the complicated appendicitis. Real World Outcomes inform institutional surgical practice and training. Methods: Two groups were compared: LA (n=140) and OA (n=80) in 220 adults in a cross sectional observational study over 18 months in a tertiary care hospital. Operative parameters, total cost, length of stay, complication status (perforated/gangrenous/abscess), AIR score, and Alvarado score were documented. Results: Mean operative time was longer in LA (64.2±18.4 vs 46.8±14.2 minutes, p<0.001). SSI was significantly lower in LA (4.3% vs 16.3%, p=0.004). Postoperative ileus (3.6% vs 11.3%, p=0.034), mean LOS (2.8 vs 5.2 days, p<0.001), and opioid requirement were also significantly lower in LA. Multivariable predictors of SSI: open approach (aOR 3.6), complicated appendicitis (aOR 2.9), diabetes (aOR 1.9), and delayed presentation >48 hours (aOR 1.7). Conclusion: Laparoscopic appendicectomy is associated with significantly lower SSI, shorter LOS, and reduced ileus compared to open approach, including in complicated appendicitis. Expansion of LA capability and training at tertiary care hospitals is recommended.
Appendicectomy; laparoscopic appendicectomy; acute appendicitis; complicated appendicitis; surgical-site infection; Alvarado score; length of stay; India.
Dr. K. Cheruvu Nataraj Navya, Dr. Haritha Oruganti
Hemodynamic Stability During Airway Instrumentation: Comparison of Direct Laryngoscopy, Videolaryngoscopy, and Laryngeal Mask Airway Techniques
Airway instrumentation during the induction of general anesthesia is well known to provoke a sympathetic-mediated cardiovascular response characterized by transient increases in heart rate and arterial blood pressure. These hemodynamic changes may be clinically insignificant in healthy individuals but can pose substantial risks in patients with cardiovascular, cerebrovascular, or other systemic comorbidities. Therefore, selecting an airway management technique that minimizes the pressor response is of considerable clinical importance. This randomized controlled trial was conducted to compare the hemodynamic responses associated with direct laryngoscopy (DL), videolaryngoscopy (VL), and laryngeal mask airway (LMA) insertion in adult patients undergoing elective surgical procedures under general anesthesia. A total of 150 patients were enrolled and randomly assigned into three equal groups (n = 50 each) according to the airway management technique used. Heart rate (HR) and mean arterial pressure (MAP) were recorded at baseline, during airway instrumentation, and at 1, 3, and 5 minutes following the procedure. The collected data were analyzed using repeated-measures analysis of variance (ANOVA) to evaluate differences in hemodynamic responses over time among the study groups. The results demonstrated that all three airway management techniques produced a transient increase in HR and MAP following instrumentation. However, the magnitude of the response differed significantly among the groups, with direct laryngoscopy producing the greatest increase and LMA insertion resulting in the smallest hemodynamic disturbance (p < 0.001). Videolaryngoscopy showed an intermediate response, significantly attenuating the cardiovascular changes compared with direct laryngoscopy. These findings suggest that LMA insertion is associated with superior hemodynamic stability, while videolaryngoscopy offers a less pronounced pressor response than conventional direct laryngoscopy, supporting their use in patients vulnerable to adverse cardiovascular effects during airway management.
Airway management; Laryngoscopy; Videolaryngoscopy; Laryngeal mask airway; Hemodynamic response; Intubation.
Dr. Hery Prabhu Alfred, Dr. Pilli Bhavani
Clinical Profile and Outcomes of Acute Organophosphorus Poisoning Correlated with Serum Cholinesterase Levels And Peradeniya Organophosphorus Poisoning Score: A Cross-Sectional Observational Study At A Tertiary Care Hospital
Background: Acute organophosphorus (OP) compound poisoning continues to be an important public health emergency in agricultural India accounting for a large proportion of poisoning deaths. The Peradeniya Organophosphorus Poisoning (POP) score and serum pseudocholinesterase (PChE) are the two indices developed to assess severity of OP poisoning but need to be systematically evaluated for combining the two and predicting the need for mechanical ventilation, intermediate syndrome and death. Methods: This is a cross-sectional observational study that recruited 180 adults with acute OP poisoning who were admitted to a tertiary care hospital during 18-month period. At admission, the POP score, the serum PChE, clinical features, treatment parameters (atropine dose, pralidoxime use), the need for mechanical ventilation, the presence of intermediate syndrome, the length of stay in the ICUs and in-hospital mortality were recorded. Results: The most prevalent compound was chlorpyrifos which accounted for 38.3%. Thirty-two.2% had severe POP score (≥8). Intermediate (14.4%) and mechanical ventilation (36.1%) required and in hospital mortality (9.4%). A negative correlation was shown between serum PChE and severity of POPs (r=−0.62; p<0.001). Independent predictors of mortality were delayed presentation >6 hours, delayed PChE <400 U/L, mechanical ventilation, and POP score ≥8 (all aOR>2.0). Conclusion: The use of the combination of both the POP score and serum PChE at admission in acute OP poisoning allows for good severity stratification. Early intensive care, appropriate atropinisation and oxime therapy, where applicable, are the mainstay of management. There is an emergency need for policy-level regulation of highly toxic OP compounds.
Organophosphorus poisoning; POP score; serum pseudocholinesterase; cholinergic toxidrome; intermediate syndrome; atropine; mechanical ventilation; India.
Dr. Kota Rahul Krishna, Dr. Sridhar Pilla
Functional Outcomes and Patient-Reported Measures After Primary Total Knee Arthroplasty For Advanced Osteoarthritis: A Cross-Sectional Observational Study At A Tertiary Care Hospital
Background: Advanced knee osteoarthritis is treated by total knee arthroplasty (TKA), which provides pain relief and function. Patient-reported outcomes (PROs) have emerged as a vital component of the assessment of TKA success but population-specific predictors of patient dissatisfaction have yet to be well described in the Indian context. This study compares functional outcomes, PROs and factors associated with dissatisfaction following primary TKA in a tertiary care center. Methods: One hundred adults who underwent unilateral primary cemented TKA for advanced primary knee OA (Kellgren-Lawrence ≥3) at a tertiary care hospital with 6–24 months’ follow-up were enrolled in this cross-sectional observational study. Outcome measures included Oxford Knee Score (OKS), Knee Society Score (KSS), WOMAC pain subscale, range of motion (ROM), and patient satisfaction (5-point Likert scale). Multivariable logistic regression identified predictors of dissatisfaction. Results: Mean OKS improved from 18 to 38 at 12 months (p<0.001); KSS-Knee from 42 to 86 (p<0.001); WOMAC pain subscale from 16 to 4 (p<0.001); ROM from 102° to 116° (p<0.001). Complication rates: SSI 3%, DVT 4%, per prosthetic infection 1%, stiffness requiring MUA 2%. Transfusion rate 14%. 86% patients were satisfied/very satisfied. Independent predictors of dissatisfaction: residual flexion <100° at 6 months (aOR 4.0), pre-operative depression (aOR 3.1), BMI ≥30 (aOR 2.2), and pre-operative flexion contracture ≥10° (aOR 2.0). Conclusion: Primary TKA achieves significant improvements in pain, function, and quality of life in the majority of patients. Pre-operative psychological optimisation, weight management, aggressive physiotherapy for post-operative ROM, and targeted patient expectation management are crucial to minimising dissatisfaction. Depression screening and rehabilitation should be incorporated into all TKA pre-operative assessment pathways.
Total knee arthroplasty, Patient-reported outcomes, Oxford Knee Score, WOMAC, Knee Society Score, Patient satisfaction, Predictors of dissatisfaction, Osteoarthritis.
Histopathological Profile and Clinical Correlates of Lymphadenopathy in A Tertiary Care Centre
In the present cross-sectional study, a total of 200 lymph node biopsy specimens were evaluated histopathologically to determine the spectrum of lymph node lesions and their clinicopathological correlations. Reactive hyperplasia was the most common diagnosis, accounting for 68 cases (34%), followed by granulomatous lymphadenitis, predominantly tuberculous in nature, observed in 56 cases (28%). Malignant lesions constituted a substantial proportion of cases, with metastatic deposits identified in 44 biopsies (22%) and lymphomas diagnosed in 32 cases (16%). Analysis of age distribution revealed that benign lesions, particularly reactive hyperplasia and granulomatous lymphadenitis, were more frequently encountered in younger individuals, whereas malignant lesions were significantly more common among older patients. Cervical lymph nodes represented the most frequent site of involvement overall, especially in reactive and granulomatous lesions. In contrast, supraclavicular lymphadenopathy demonstrated a strong association with malignancy, particularly metastatic disease. Node size also showed significant correlation with histopathological diagnosis, with larger lymph nodes more frequently harboring malignant pathology. Similarly, lymph nodes with a longer duration of enlargement prior to presentation were significantly associated with metastatic and lymphomatous lesions compared with reactive and infective conditions. Statistical analysis using chi-square testing demonstrated significant associations between histological diagnosis and clinical variables including patient age, lymph node site, node size, and duration of lymphadenopathy (p < 0.05). The findings highlight the diverse pathological spectrum of lymphadenopathy and emphasize the importance of integrating clinical characteristics with histopathological examination. Histopathology proved invaluable in distinguishing benign from malignant conditions and provided definitive diagnostic information necessary for appropriate patient management and therapeutic decision-making.
Lymph node; Histopathology; Lymphadenopathy; Tuberculosis; Metastasis; Lymphoma.
Incidental Thyroid Nodules Detected on CT and MRI: Frequency, Ultrasound Risk Stratification, and Clinical Outcomes in a Cross-Sectional Study
Background: Incidental thyroid nodules (ITNs) are increasingly detected on computed tomography (CT) and magnetic resonance imaging (MRI) performed for non-thyroid indications. Although most incidental nodules are benign, a small proportion may represent thyroid malignancy, creating challenges regarding appropriate evaluation and management. Understanding the frequency, imaging characteristics, and outcomes of ITNs is important for developing evidence-based diagnostic pathways. Objective: To determine the frequency of incidental thyroid nodules detected on CT and MRI examinations and to evaluate their ultrasound characteristics, cytological findings, and malignancy outcomes. Methods: This cross-sectional study reviewed 1,500 CT and MRI examinations that included visualization of the thyroid gland and were performed for non-thyroid clinical indications. Incidental thyroid nodules were identified and characterized according to size, multiplicity, and imaging features. Nodules meeting established criteria underwent dedicated thyroid ultrasonography and were classified using the American College of Radiology Thyroid Imaging Reporting and Data System (ACR TI-RADS). Fine-needle aspiration cytology (FNAC) and histopathological findings were reviewed where available. Data were analyzed descriptively using frequencies, percentages, and summary statistics. Results: Incidental thyroid nodules were identified in 225 of 1,500 examinations, yielding an overall frequency of 15%. The prevalence was 16% on CT and 13% on MRI. The median nodule size was 9 mm (interquartile range: 6–14 mm), and multiple nodules were present in 68 patients (30%). Ninety patients (40%) underwent dedicated thyroid ultrasonography, while 27 patients (12%) underwent FNAC. Among evaluated nodules, 41 (46%) were classified as ACR TI-RADS TR1–TR2, 27 (30%) as TR3, 16 (18%) as TR4, and 6 (6%) as TR5. Only two nodules (2%) were confirmed as malignant on cytological or histopathological examination. The majority of incidental nodules therefore demonstrated low-risk ultrasound characteristics and did not require invasive intervention. Conclusion: Incidental thyroid nodules are common findings on CT and MRI examinations performed for non-thyroid indications; however, the prevalence of malignancy is low. Most nodules exhibit low-risk ultrasound features and can be managed conservatively. A selective, guideline-based approach incorporating ultrasound risk stratification and targeted FNAC appears effective for identifying clinically significant lesions while minimizing unnecessary investigations and interventions.
Incidental thyroid nodule, thyroid incidentaloma, computed tomography, magnetic resonance imaging, ultrasonography, ACR TI-RADS, fine-needle aspiration cytology, thyroid cancer.
Clinical Spectrum, Severity Indicators, and Outcomes of Hospitalised Adults with Dengue: A Cross-Sectional Observational Study At A Tertiary Care Hospital
Background: Dengue is the fastest growing vector borne viral disease in the world. Dengue is one of the highest burden diseases in the Southeast Asian region and hospitalised adult dengue is a wide spectrum disease ranging from febrile illness to severe dengue with plasma leakage, severe bleeding and organ failure. Predictors of progression to severity are important in terms of triage and resource allocation. Methods: The cross sectional observational study involved 350 hospitalised adults who were positive for NS1 antigen and/or IgM antibody of dengue (WHO 2009 classification) during one monsoon season in a tertiary care hospital. Clinical features, sequential laboratory parameters, and outcomes were recorded. Results: Warning signs: 41.1% and severe dengue: 12.3% occurred. Thrombocytopenia <20,000/µL occurred in 24.0%; AST >3× ULN in 28.3%; transfusion requirement in 9.1%; ICU admission in 14.3%; mortality 1.4%. AST >500 U/L, serum albumin <3 g/dL, age >45 years and presence of diabetes were independent multivariable predictors of severe dengue with aORs of 4.2, 3.6, 2.1, and 1.9, respectively. Conclusion: Dengue with warning signs and severe dengue affect a substantial proportion of hospitalised adults. Elevated AST and hypoalbuminaemia are strong independent severity predictors that can guide triage decisions. Judicious fluid management and vigilance for plasma leakage are cornerstones of effective clinical management.
Dengue; severe dengue; NS1; thrombocytopenia; plasma leakage; WHO 2009 classification; warning signs; dengue haemorrhagic fever.
Dr. Duggirala Pujitha Chowdary, Dr. Nirmal Kumar
Three-Dimensional Segmental Stability of Multi-Piece Le Fort I Osteotomies vs. Single-Piece Maxillary Advancements in Cleft Lip and Palate Patients
Background and Objective: Cleft lip and palate (CLP) patients frequently develop mid-facial hypoplasia necessitating orthognathic surgical intervention. The optimal approach—multi-piece Le Fort I osteotomy (MP-LFI) versus single-piece maxillary advancement (SP-MA)—remains contested, particularly regarding three-dimensional (3D) skeletal stability. This study prospectively compared 3D segmental stability, occlusal outcomes, and patient-reported quality of life at 24 months between the two techniques. Methods: A prospective cohort study enrolled 100 skeletally mature CLP patients (52 MP-LFI; 48 SP-MA) at a tertiary craniofacial centre between January 2022 and December 2023. Cone-beam computed tomography (CBCT) with 3D cephalometric analysis was performed preoperatively, and at 1, 3, 6, 12, and 24 months postoperatively. Primary outcomes included 3D skeletal relapse vectors across the anteroposterior (X), vertical (Y), and transverse (Z) axes. Secondary outcomes comprised occlusal stability indices, patient-reported outcomes (PROs) using a 100-mm Visual Analogue Scale, and complication rates. Results: At 24 months, the MP-LFI group demonstrated significantly lower total 3D relapse (3.1 ± 1.0 mm vs. 6.2 ± 1.7 mm; p < 0.001) and superior retention of planned movement (65.1% vs. 38.4%; p < 0.001). Stable occlusal outcomes (≤2 mm relapse) were achieved in 74.0% of MP-LFI patients versus 52.1% of SP-MA patients (p = 0.023). Quality of life scores were significantly higher in the MP-LFI cohort across all domains (p < 0.05). Complication rates were lower in the MP-LFI group (11.5% vs. 18.8%). Conclusion: Multi-piece Le Fort I osteotomy provides superior three-dimensional skeletal stability over single-piece maxillary advancement in CLP patients at 24-month follow-up. The MP-LFI technique should be considered the approach of choice in patients with moderate-to-severe maxillary hypoplasia, transverse discrepancies, and arch constriction.
Cleft lip and palate; Le Fort I osteotomy; orthognathic surgery; skeletal stability; three-dimensional cephalometry; maxillary advancement; CBCT; mid-facial hypoplasia; multi-segment osteotomy.
Self-Improving Frontier Agents for Insurance Operations: A Governed Architecture for Autonomous Claims Reasoning And Workflow Adaptation
Frontier artificial intelligence models have demonstrated unprecedented advancements in multi-hop reasoning, tool-use, and interpretive capabilities across complex domains. Despite these advances, regulated industries such as insurance remain constrained by static automation, brittle rule systems, and manual adjudication processes. Current large language model (LLM) deployments in enterprise settings utilize retrieval-augmented generation or simple tool-routing frameworks but lack the ability to improve autonomously over time, restricting operational scalability and consistency. Here we introduce Self-Improving Frontier Agents (SIFA)—a governed, autonomous agentic architecture integrating frontier models (e.g., GPT-o3, Claude 3.5 Opus, Nova Pro) with continuous self-improvement loops, synthetic data generation, human-in-the-loop corrections, and auditable reasoning traces. SIFA dynamically refines claims reasoning, policy interpretation, and workflow steps through governed adaptation pipelines while maintaining compliance and transparency required for regulated enterprise environments. To our knowledge, this is the first documented application of self-improving frontier agents in the insurance domain, bridging a gap between frontier reasoning capabilities and real-world adjudication workflows. We establish the conceptual framework, architecture, implementation methodology, metrics, and governance model necessary for such deployments, and outline implications for broader regulated industries.
Self-Improving Agents, Frontier AI Models, Insurance Claims Adjudication, Governed Adaptation, Retrieval-Augmented Generation.
Venkata Harikishan Koppuravuri, Abhishek Kumar, Karthik Budige
Explainable Federated Deep Learning for Low-Cost and Privacy-Preserving Early Breast Cancer Screening to Reduce U.S. Healthcare Burden
Breast cancer, which overall has an established survival rate of 74% - compared to a progressively increasing 99% within the last 30 years, making early detection essential in improving prognoses - is both sensitive and difficult for clinicians. To overcome the above challenges, in this paper, we propose FedXAI-DP: a novel framework for privacy-preserving breast cancer classification that synergistically combines Federated Learning (FL), Explainable Artificial Intelligence (XAI), and Differential Privacy (DP). FedXAI-DP performs a SHAP-importance-weighted aggregation, where more important clients are given higher or lower weights proportionally in constructing the global model, as compared to existing FL strategies that aggregate model parameters uniformly for each client. This allows more discriminative feature information to rule the global update in the heterogeneous and non-IID client data. Surprisingly, we find under IID data conditions by experimenting on the Wisconsin Breast Cancer Dataset (WBCD, n=569) that FedXAI-DP achieves 98.25% accuracy and AUC-ROC =0.9950, exactly matches centralized training performance while assuring zero access to raw data. Even under realistic non-IID scenarios, the federated model only costs a 1.76% overhead compared to the centralized upper bound whilst achieving an accuracy of 96.49%. We perform a detailed privacy-utility tradeoff analysis across epsilon 2.0, 5.0, 10.0, and 20.0 that quantifies the cost in accuracy from formal privacy guarantees. SHAP analysis ranks radius_mean, area_worst and concave_points_worst as the clinical features most impactful, offering actionable explainability from a pathologist's perspective.
Federated Learning; Explainable AI; SHAP; Differential Privacy; Breast Cancer Detection; Non-IID; Privacy-Preserving Machine Learning; FedAvg.
Md Ismail Hossain Siddiqui, Kanchon Kumar Bishnu, Mohd Abdullah Al Mamun, Mohon Raihan, Araf Islam, Sonia Akter, Iftekhar Hossain
Comparison of Early Versus Delayed Rehabilitation Following ACL Reconstruction
Background: Anterior cruciate ligament (ACL) injury is a common orthopedic condition affecting physically active individuals and often results in knee instability, reduced functional capacity and impaired quality of life. Postoperative rehabilitation plays a crucial role in recovery following ACL reconstruction. However, the optimal timing of rehabilitation initiation remains controversial, particularly in resource-limited settings such as Bangladesh. This study aimed to compare the functional outcomes and postoperative complications between early and delayed rehabilitation following ACL reconstruction. Methods: This comparative observational study was conducted in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh, from January to December 2021. A total of 60 patients undergoing primary unilateral arthroscopic ACL reconstruction were enrolled and divided equally into early rehabilitation (n=30) and delayed rehabilitation (n=30) groups. Functional outcomes were assessed using IKDC, Lysholm, Tegner activity, VAS pain scores, knee range of motion and postoperative stability tests. Statistical analysis was performed using SPSS version 25.0. Results: Baseline characteristics were comparable between the groups. At six months, the early rehabilitation group demonstrated significantly higher IKDC scores (84.6±6.8 vs 78.2±7.5; p=0.001), Lysholm scores (89.1±5.9 vs 82.7±6.7; p<0.001), Tegner activity scores (6.2±1.1 vs 5.4±1.0; p=0.006) and greater knee flexion range of motion (132.4±7.1° vs 125.8±8.3°; p=0.002). Lower VAS pain scores and fewer postoperative complications were also observed in the early rehabilitation group. Conclusion: Early rehabilitation following ACL reconstruction resulted in better functional recovery and lower complication rates than delayed rehabilitation.
ACL reconstruction, rehabilitation, early mobilization, knee function.
Dr. Md. Imamur Rashid, Prof. Dr. M.A. Shakoor, Dr. Nadia Rahman, Dr. Mohammad Golam Nobi, Dr. Mohammadullah
Predictors of Surgical Intervention in Neonates with Necrotizing Enterocolitis: A Retrospective Study
Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal emergency in neonates with high death and morbidity. Aim: This study aimed to recognize demographic, laboratory, and clinical predictors related to the need for surgical management in neonates with NEC. Methods: This retrospective observational study was conducted on 200 patients over a three-year period in a tertiary neonatal intensive care unit. Neonates diagnosed with NEC (Bell’s stage II or III) were included and divided into surgical and conservative management groups. Results: A total of 200 neonates with NEC have been involved; 45 required surgical intervention, and 155 were managed conservatively. Neonates in the surgical group had significantly lower gestational age and birth weight (p under 0.001). Severe clinical features, including abdominal distension, abdominal rigidity, weak bowel sounds, poor mental reaction, tachycardia, and advanced Bell’s stage, were significantly more prevalent in the surgical group (p below 0.05). Multivariate analysis recognized CRP and lactate as independent predictors of surgical intervention, while higher gestational age, absolute lymphocyte count, and white blood cell count were protective. ROC analysis showed good predictive accuracy for CRP (AUC = 0.792). Conclusion: Prematurity, low birth weight, severe clinical presentation, and elevated inflammatory and metabolic markers are strongly associated with surgical NEC. CRP, in particular, is a reliable predictor and can aid in early recognition of high-risk neonates, facilitating timely surgical decision-making and improved outcomes.
Necrotizing enterocolitis; Surgical intervention; C-reactive protein; Neonates.
Hatem W Alsherbiny, Tharwat Hussein, Hasan A Adly, Alsayed M Othman MD, Taha Sobhy Taha, Reda Alkady
Workplace Violence Against Nurses and Its Association With Job Satisfaction and Turnover Intention
Workplace violence (WPV) directed towards nurses is one of the most serious health issues worldwide, having far-reaching consequences for healthcare provision, nurses’ well-being, and organizations’ internal functioning. This literature review presents a state-of-the-art research in terms of current evidence obtained in recent years (2020–2024) regarding prevalence, causes, and outcomes of workplace violence directed toward nurses, especially concerning its connection with nurses' job satisfaction and turnover intention. Based on systematic reviews, meta-analysis, and large cross-sectional studies conducted in different geographical regions such as Ethiopia, China, USA, and the UK, this paper shows that workplace violence affects from 43.4% to 89.6% of nurses according to the type and settings. In addition, the presented results show that job satisfaction acts as an important mediating variable explaining the link between workplace psychological violence and turnover intention, accounting for 43.97% of the total effect. According to hierarchical regression analysis, workplace violence contributes 32.5% of turnover intention variance when controlling demographic variables. The obtained results emphasize the necessity to implement evidence-based organizational changes, policy reforms, and culture changes in order to prevent nurses’ violence-related injuries and improve their satisfaction, thereby alleviating the problem of worldwide nursing shortage due to nurse turnover.
Workplace Violence, Nurses, Job Satisfaction, Turnover Intention, Healthcare, Occupational Safety, Nursing Retention.
Deema Fuad Abdullah Haneef, Jebreen Omayrah Almarashi, Razaz Hussain Bajal, Ghazal Ahmed farajallh Al- thalabi ,Alaa Abdullah Al Subhi, Tariq Ahmed Abdullah Alzahrani, Khalid Abdulrahman alzahrani
Large Language Models for Automated Healthcare Data Dictionary Generation and Maintenance
Data dictionaries enable consistent and reliable communication within and between healthcare organizations but are often incomplete, inconsistent, outdated, or poorly maintained. A methodology harnessing large language models (LLMs) facilitates the automated inception, augmentation, and upkeep of data dictionaries and associated artifacts throughout their lifecycle. Experimental results on an end-to-end data dictionary generation pipeline highlight considerable improvements in artifact quality, with specific categories prepared at least an order of magnitude faster than by human expert contributors. The approach addresses two crucial yet largely neglected aspects of data dictionary governance: the identification of new attributes within hospital information systems and the assessment of impact from proposed changes. In healthcare, data dictionaries describe the information content supported by a system. These dictionaries help facilitate interoperability and data-sharing by formally documenting core knowledge (such as metadata about entities and attributes), by enabling data sharing in an external dataset against which new datasets can be validated, and by providing domain knowledge about external datasets for data fusion, data integration, and machine learning. Nevertheless, many platforms do not have data dictionaries of any kind, and the quality of those that do is often poor. Poor-quality data dictionaries suffer from a range of problems, including incompleteness, inconsistency, outdated content, and lack of audit trails for historical queries. Poor-quality (and missing) data dictionaries also impact data governance by slowing down and increasing the risk in aspects such as the identification of privacy-sensitive fields, the preparation of new data-sharing contracts, and impact assessments for schema changes.
Healthcare Data Dictionaries, LLM-Based Data Governance, Automated Metadata Management, Data Dictionary Automation, Healthcare Data Interoperability, Metadata Quality Improvement, Schema Change Impact Analysis, Data Governance Frameworks, Clinical Data Standardization, Intelligent Data Documentation
Bindu Madhavi Mangalampalli, Sasi Kumar Kolla
Deep Vein Thrombosis and Pulmonary Embolism: A Shared Postoperative Concern in Prolonged Immobilised Patients
Venous thromboembolism (VTE), encompassing deep vein thrombosis (DVT) and pulmonary embolism (PE), represents a major preventable cause of morbidity and mortality among postoperative and prolonged immobilized patients. Despite advances in surgical care, anesthesia, and anticoagulant therapy, VTE continues to be a significant global health challenge. Postoperative immobility, endothelial injury, and hypercoagulability—collectively known as Virchow’s triad—remain the cornerstone mechanisms driving thrombus formation. Surgical stress, tissue trauma, and prolonged bed rest further exacerbate venous stasis and clot propagation. Clinically, DVT often presents with unilateral leg swelling and pain, while PE manifests with dyspnea, chest pain, or hemodynamic instability, although many cases remain asymptomatic until complications arise. Early diagnosis through clinical scoring systems, D-dimer assays, ultrasonography, and computed tomography pulmonary angiography is crucial to prevent fatal outcomes. Preventive strategies, including pharmacologic prophylaxis with heparins or direct oral anticoagulants, mechanical compression, and early mobilization, have proven highly effective. However, variations in clinical practice, underdiagnosis, and inadequate adherence to prophylactic protocols persist, particularly in resource-limited settings. Future research should emphasize risk-based individualized prevention, development of national guidelines, and incorporation of artificial intelligence for improved prediction and early detection. A multidisciplinary approach integrating clinicians, nurses, and physiotherapists is essential to minimize postoperative VTE burden and improve patient outcomes.
Venous thromboembolism, Deep vein thrombosis, Pulmonary embolism, Postoperative immobility, Prophylaxis.
Dr Prithvansh Malhotra, Dr RK Shinde, Dr Pooja Batra, Dr Muskaan Singhal, Dr Jaideep Reddy R