What is Journal of Carcinogenesis? Despite the advances in the treatment of cancer and the increasing knowledge of the processes responsible for the disease, there is a gap in the understanding of molecular events leading to cancer and the mechanisms of action by anticancer agents. The field of carcinogenesis is far from being completely explored. Many novel ideas and concepts still need to be introduced into the field, and the results of several provocative experiments are yet to be disseminated and shared. There is a need for multidisciplinary research in the field and a forum for accelerated publication of results. These are the considerations that led to the birth of the online journal, Journal of Carcinogenesis. Journal of Carcinogenesis is a peer-reviewed, online journal designed to bring together many aspects of research to develop the understanding of carcinogenesis. Edited by Gopala Kovvali, Journal of Carcinogenesis is supported by an international Editorial Board. 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AI-Driven Precision Oncology Prediction: Deep Learning–Driven Early Detection of Carcinogenesis Using Multi-Omics Data Integration
One of the most essential issues concerning oncology medicine is the possibility to detect the carcinogenesis early enough. This paper demonstrates a new deep learning system, called Deep Learning Multi-Omics Integration (DL-MOI), to AI-assisted precision oncology by early carcinogenesis detection of detected multi-omics data. The suggested architecture integrates Convolutional Neural Networks (CNNs) with the long Short-term memory (LSTM) networks and Transformer encoders into the framework of attention-based fusion in order to concomitantly accommodate genomic, transcriptomic, proteomic and epigenomic forms of data. With a mean area under the receiver operating characteristic curve (AUC) of 0.976, an overall accuracy of 96.1, sensitivity of 95.7 and specificity of 96.8, TCGA (n = 11,432 samples, 7 cancer types) on the TCGA produced a multi-caner prediction model (DL-MOI). TP53 mutation frequency, BRCA1/ 2 methylation status, and MYC copy-number variation were the three dominant biomarkers identified through SHAP-based interpretability analysis. The results of the comparative benchmarking results over five of the state-of-the-art techniques showed the same degree of improvement in all evaluation measures. The DL-MOI framework constitutes a clinical intervention and biologically comprehensible solution to multi-cancer early diagnosis with a potential of individual therapeutic intervention.
Precision oncology; deep learning; multi-omics integration; carcinogenesis; early cancer detection; CNN; LSTM; Transformer; SHAP; TCGA; biomarker discovery.
Anwar Jahid, Md Sazidul Islam, Md Omar Obaid
Patterns of sexual assault evidence and forensic evaluation: a systematic review and meta-analysis
Background: The assessment of anogenital injury is a key element in both the clinical and forensic evaluation of a sexual assault. Nevertheless, the presence of injuries is not uncommon after a consensual act of intercourse, which inevitably raises difficulties in interpretation and medico, legal decision, making. Different prevalence of injuries, methods to detect them and individual biological characteristics have contributed to make forensic assessment even more complex. The authors of this research have been trying to gather and integrate systematically evidence on the characteristics of anogenital injury after sexual assault and consensual intercourse. Besides, they have also attempted to identify and understand the role of factors that change the detection of injury and its interpretation. Methods: A systematic review and meta, analysis were conducted based on eight primary comparative and methodological studies, which were complemented by additional literature. Eligible studies were those that examined adult female populations after forensic or medical examination following sexual assault, consensual intercourse, or both. Data extracted comprised study characteristics, injury prevalence, anatomical distribution, injury type, and forensic examination methods. Besides pooled prevalence estimation, qualitative synthesis was also done to compare the injury patterns across exposure groups and to assess the impact of examination techniques. Results: Across the studies included, the overall percentage of any anogenital injury was pooled and the prevalence of that pooled anogenital injury was estimated at 66% after sexual assault and 48% following consensual intercourse, thus survivors of sexual assault had higher injury occurrence but still with a great overlap. Abrasions and erythema were typical of both groups, whereas lacerations and bruising were more commonly linked with sexual assault. In general, the injuries distribution was most commonly located at the posterior fourchette and labial areas. Detection rates of injuries were very different depending on the way the examination was conducted. That is, injury identification was increased by colposcopy and toluidine blue dye as adjunctive techniques compared with naked eye examination. Besides that, biological and situational factors, such as tissue characteristics, previous sexual experience, age, and the time of the examination, were shown to have a significant impact on the presence and visibility of injuries. Conclusion: Anogenital injuries are a common complaint among sexual assault survivors, but there is significant overlap with injuries resulting from consensual intercourse, which means that the presence of an injury alone has limited diagnostic specificity. Therefore, forensic interpretation should weigh physical findings along with clinical history and contextual evidence. It is crucial to standardize examination protocols and carry out further research on the biological and methodological factors of injury to enhance forensic sexual assault assessment accuracy and fairness
Sexual assault, Anogenital injury, Consensual intercourse, Forensic examination, Genital trauma patterns, Injury detection methods.
Dr Soma Dash, Dr. Pratyush Mishra, Dr. Priyatosh Dash, Dr.Subhasish Sahu
Impact of Lifestyle and Dietary Interventions on Preeclampsia Prevention: A Systematic Review and Meta-Analysis.
Background: Preeclampsia is still one of the major causes of maternal and perinatal deaths worldwide. New studies are showing more and more the role of changing diet and lifestyle in the prevention of the disease. This systematic review and meta-analysis looked at the role of dietary and lifestyle interventions in preventing preeclampsia by incorporating the data from the latest clinical trials, observational studies, and global guidelines. Methods: A thorough search across leading databases was done to locate research on diet-based interventions - covering calcium, vitamin D, folic acid, and multimicronutrient supplementation - and lifestyle methods like organized workout sessions and weight-control schemes. The qualifying articles were checked following the PRISMA procedure, and the information was combined with a random-effects method. Results: Thirty-eight studies passed the filter. Starting calcium before conception or early in pregnancy cut preeclampsia risk sharply. Vitamin D and mixed micronutrients helped a bit, Mainly where levels were low at start. Exercise and weight advice added value, but diet plus lifestyle worked best overall. Global guidelines say the same - get nutrients early, target prevention where needed. Conclusion: Dietary and lifestyle changes have a significant impact on lowering preeclampsia risk. Therefore, they need to be a part of standard antenatal care, especially for high-risk and nutrition-deficient groups. A combination of various factors, such as calcium intake through supplements, enough micronutrients, healthy food choices, and personal habit changes, can be a great way to lessen worldwide preeclampsia cases. More carefully planned experiments shall be made before making program decisions and providing recommendations, as there is room for increasing our pool of robust data
Preeclampsia Prevention, Calcium Supplementation, Maternal Nutrition, Lifestyle Interventions, Micronutrient Supplementation, Pregnancy Outcomes .
Dr Soubhagya Mayee Sahoo, Dr Baishnavi Ray
Dr Dhurjati Prasad Mahapatra, Dr Maheswar Bahu Balendra Singh
Role of Herbal Medicines in Management of Cancer
Cancer remains a major global health burden with increasing incidence and mortality worldwide. Despite advances in conventional treatment modalities such as chemotherapy, radiotherapy, and surgery, cancer management continues to be challenged by treatment-related toxicity, reduced quality of life, and disease recurrence. This has led to growing interest in complementary and alternative systems of medicine, particularly herbal and natural compounds, for supportive and integrative cancer care. Natural products derived from plants, animals, and microorganisms have long been used for cancer prevention and therapy and form the basis of several modern anticancer drugs. These compounds exert anticancer effects through multiple mechanisms, including antioxidant activity, induction of apoptosis, inhibition of inflammation and angiogenesis, modulation of detoxification enzymes, and regulation of key molecular signaling pathways. The present review discusses the global burden of cancer, the limitations of conventional therapies, and the role of herbal medicines and natural compounds in cancer prevention and treatment, with emphasis on their mechanisms of action and evidence from experimental and clinical studies.
Cancer; Herbal medicines; Natural compounds; Apoptosis; Antioxidants; Complementary therapy
Dr. Jyoti Meghdambar, Dr.Rutuja Chavhan, Dr. Vinayak Navanale
Effectiveness of Gender Equality Health Education Program on Knowledge of Adolescents in Vadodara, Gujarat
Background: The transitional phase of adolescence is vital for the development of attitudes concerning social behaviors, health practices, and gender roles. A prevailing lack of awareness regarding interpersonal relationships, reproductive rights, and gender equity frequently results in harmful stereotypes and subsequent health challenges. Objectives: The primary aims of this investigation were to evaluate the baseline understanding of gender equality among adolescents and to determine the effectiveness of a targeted health education program in bridging these knowledge gaps. Methods: A quasi-experimental study utilizing a single-group pre-test and post-test design was conducted. The sample consisted of 100 school-going adolescents from Vadodara, Gujarat, selected via simple random sampling. Data collection was executed using a validated, structured questionnaire. The gathered data underwent descriptive and inferential statistical analysis, specifically utilizing paired t-tests and chi-square statistics to ascertain the educational intervention's impact and explore demographic associations. Results: The analysis demonstrated a substantial enhancement in the participants' comprehension following the educational intervention. The proportion of students with poor knowledge dropped drastically from 62% to 24%, while those exhibiting average knowledge surged from 35% to 73%. Furthermore, variables including age, gender, and geographical region exhibited highly significant statistical associations with post-test scores (p < 0.001). The primary source of information regarding gender concepts also significantly influenced learning outcomes (p = 0.007). Conclusion: The implementation of a structured gender equality health education program proved highly efficacious in augmenting adolescent awareness. Such interventions play an instrumental role in dismantling gender stereotypes and fostering positive, equitable attitudes among the youth.
Gender equality, health education, adolescents, reproductive rights, knowledge improvement.
Prof. Karthika S, Maulik Chhatrola, Jevil Suthar, Ayush Vyas, Pooja Dhaka
Carcinoma of unknown primary site (CUPS): case series.
Background:Carcinoma of unknown primary sites(CUPS)are group of malignancies which present with widespread metastasis without an identifiable primary.3 -5% of all malignancies can present as CUPS. The clinical behavior of these cancers is usually aggressive and prognosis remains poor. Materials and methods:From January 2023 toaugust 2025,total 19 cases of CUPS were registered in our department for whom the data were collected and analyzed. Results: Median age at presentation of our patients was 51 years(27 -75 years). 42.1 %( n=8) were females and 57.9 %( n=11) were males. Mean ECOG PS of patients was 2±1.1. Median number of sites involved were 2(1-5).In 26.3%(n=5) patients site of biopsy was lymphnode,21%(n=4),from liver and 10.5%(n=2) were diagnosed by fluid cytology . Morphologically 63.2% (n=12) biopsies were adenocarcinoma,15.8%(n=3) poorly differentiatedcarcinoma,10.5%(n=2) poorly differentiated squamous cell carcinoma,5.3%(n=1) each as poorly differentiated adenocarcinoma and adenoid cystic carcinoma. After immunohistochemistry (IHC) amongst the 12 adenocarcinoma patients CK7 was positive in 58.3%(7/12),CK20, PanCK in41.6%(5/12)each,CK19in25%(3/12)andCDX2andTTF1in8.3%(1/12). Poorly differentiated squamous cell carcinoma and adenoid cystic carcinoma histology had 100% P63 positivity. Poorly differentiated carcinomas showed PanCK positivity in 66.6%(n=2),EMA and TTF1 positivity in 33.3%.PET CT was done in 15.7 %( n=3).Primary was apparent in only 2 out of 19 cases (10.5%).After diagnosis 11 patients received chemotherapy, 2 patients received Radiotherapy (1 palliative and 1 radical dose) and 3 patients underwent surgery. Among 11 patients who received chemotherapy median number of chemotherapy cycles given was 4(1-7). 45.4% (n=5) received gemcitabine based chemo, 36.3 %( n=4) paclitaxel and carboplatin, 18 %( N=2) received capecitabine and oxaliplatin.36.3%(N=4)completed the desired number of chemotherapy cycles with 50% CR and 50% PR rates.3 out of 8 patients who were not candidate for chemotherapy received empiricalgeftinib. Median follow of our study was 11.4 months with median progression free survival (PFS) of 6.7±3.2 months (95% CI 0.37 -13.0), median overall survival (OS) 6.9±3.2 months (95%CI 0.57 -13.2).
Primary Extra-nodal Non-Hodgkin Lymphoma (excluding Gastrointestinal Lymphoma, Testicular and primary CNS lymphoma)-A case Series.
Primary extranodal non-Hodgkin lymphoma (NHL) is a rare disease contributing 5% of all NHL. Our aim isto describe the clinical presentation of extranodal lymphoma at various sites with focusing treatment aspect
A Qualitative Theoretical Framework for Integrating Family Medicine, Public Health, Epidemiology, and Nursing Technical Roles in Community-Oriented Healthcare Systems
This study provides a comprehensive theoretical exploration into the integration of family medicine, public health, epidemiology, and nursing within community-oriented healthcare systems. The research aimed to construct a qualitative theoretical framework capable of bridging disciplinary boundaries to promote continuity, collaboration, and equity in health service delivery. Through an extensive review of 98 theoretical and empirical sources published between 2015 and 2025, the study identified recurring themes and interprofessional linkages that shape the foundation of integrated healthcare. The results demonstrated that epidemiology and public health maintain the strongest theoretical connection, forming the analytical and preventive backbone of integrated health systems. Family medicine emerged as the central discipline for clinical continuity, while nursing showed exceptional strength in community engagement and patient empowerment. The analysis further revealed that preventive health promotion (21.8%) and health equity (19.5%) are the most recurrent integration themes in contemporary literature, reinforcing the global emphasis on community-based, inclusive, and evidence-driven healthcare. These findings underscore that integration across disciplines depends not merely on organizational coordination but also on shared values, educational alignment, and cross-sector governance. The resulting Multi-Disciplinary Integration Model (MDIM) provides a structured framework that captures professional, functional, and outcome-oriented dimensions, illustrating how diverse health disciplines can collaborate to achieve population-level resilience and equity. Overall, the study concludes that sustainable integration requires a balance between data-informed governance, preventive strategies, and person-centered care. By aligning theory with practice, the framework offers valuable guidance for policymakers, educators, and healthcare professionals seeking to design equitable, community-responsive health systems.
Family Medicine, Public Health, Epidemiology, Nursing, Theoretical Framework, Community-Oriented Healthcare, Integration, Interprofessional Collaboration, Health Equity, Population Health.
Majed Ahmed Almogbel, Ahmad Khalid Ahmad Alghamdi, Abdulrahman Hussain Salman Abdali, Abdulrhman Mohammed Alqarni, Mohammed Ali Attiah Alharbi, Shabib Abdulrahman Hamoud Alsubaie, Reem Ibrahim Ali Asiri, Mariam Attyah Slaeh Alghamdi, Ibrahim Mohammed Hass
Comparative Efficacy of Preoperative Nebulized Dexmedetomidine, Ketamine, and Magnesium Sulphate for Prevention of Postoperative Sore Throat following Laparoscopic Surgery: A Randomized, Double-Blind Trial
Background: Postoperative sore throat (POST) after tracheal intubation is common and distressing. Nebulized topical agents (dexmedetomidine, ketamine, magnesium sulfate) reduce mucosal nociception and inflammation but comparative data remain limited. Objective: To compare the efficacy and safety of preoperative nebulized dexmedetomidine, ketamine, and magnesium sulphate in preventing POST in adult patients undergoing elective laparoscopic surgery under general anesthesia. Methods: A randomized, double-blind, three-arm trial enrolled 100 adults (age 18–65, ASA I–II) undergoing elective laparoscopic procedures. Patients were randomized to receive nebulized dexmedetomidine 1 µg/kg (Group D, n = 34), ketamine 50 mg (Group K, n = 33), or magnesium sulphate 250 mg (Group M, n = 33) diluted to 4–5 mL and administered via mouthpiece 30 minutes before induction. Endotracheal tube size and cuff pressure (20–25 cmH₂O) were standardized. Primary outcome was incidence of POST at 6 h. Secondary outcomes included incidence at 0, 2, 12, 24 h; severity (4-point scale); hoarseness, cough, sedation, hemodynamic events, and adverse effects. Results: Baseline demographics and intraoperative variables were comparable across groups. At 6 h, POST incidence was significantly lower in Group D (3/34, 8.8%) than Group K (9/33, 27.3%) and Group M (11/33, 33.3%) (p = 0.02). Severity was predominantly mild; no severe POST reported. Transient sedation and two episodes of bradycardia (Group D) were observed; no serious adverse events occurred. Conclusions: Preoperative nebulized dexmedetomidine (1 µg/kg) reduced incidence and severity of POST at 6 h compared with nebulized ketamine (50 mg) and nebulized magnesium sulphate (250 mg), with acceptable safety. Larger multicenter trials are warranted.
postoperative sore throat; nebulization; dexmedetomidine; ketamine; magnesium sulphate; randomized trial.
Dr. Mohd Fazal Ahmed Makki, Dr. Aravind N Babu, Dr. Vishal Jainth, Dr. Sushil Ambesh, Dr H N Madhusudana, Dr. Deepak Shukla, Dr. Rachna Verma, Dr. Sanni Deyol Gautam, Dr. Syed Shadman Ahmad
Comparative Evaluation of Rifampicin Powder Dressing versus Betadine Dressing in Lower Limb Ulcers Using the Bates-Jensen Wound Assessment Tool (BWAT): A Prospective Randomized Controlled Study1st author
Introduction: Ulcer is defined as breech in epithelium or mucosa. Lower limb ulcers are most commonly due to venous, arterial or neuropathic causes. Most commonly in India the lower ulcers are due to a venous pathology whereas in JSS hospital the most common cause of lower ulcers was found to be diabetes mellitus. Objectives: To assess wound healing of lower limb ulcers in patients treated with local application of rifampicin powder dressing using BATES-JENSEN Wound Assessment Tool (BWAT) at 3, 5. Methodology: This study is a prospective interventional randomized control study which was conducted over a period of 18 months, with 100 patients participating in the study amongst which 50 patients underwent betadine dressing (Group A) and 50 patients underwent rifampicin dressing (Group B). After patient have been selected the ulcer will be scored according to BWAT score and that will be considered the baseline score of the ulcer. Under sterile precautions the ulcer will be cleaned and thorough debridement will be done. Rifampicin 150mg capsules containing rifampicin powder will be used for the local application over the ulcer. Results: The study showed significant decrease in size of the ulcer, decrease in exudate amount, peripheral tissue edema and induration in patients treated with rifampicin dressing when compared with ulcers treated with betadine dressing. There was also significant increase in granulation tissue for the ulcers treated with rifampicin dressing. 52% patients who underwent rifampicin dressing were found have no growth in the pus culture implying reduction in bacterial load of the ulcer. Conclusion: Rifampicin is a cheap drug which is easily available all over India. Local application of rifampicin is an easy method of local antibiotic application to treat the lower limb ulcers to hasten the process of wound healing and decrease the need for debridement and prepare the ulcers earlier for SSG.
Lower limb ulcers, rifampicin powder dressing, Betadine dressing, Wound healing, Bates-Jensen Wound Assessment Tool (BWAT)
Dr Deepak Naik P, Dr Nayana Priyavadan Bhortakay, Dr Ganashree M H, Dr Tulasi Vasudeviah, Dr Sankar Chandra Vadan
Nurses’ Adherence to Vital Signs Monitoring and Its Association with Early Warning Score Accuracy
Background: Accurate vital signs monitoring is essential for patient safety, as it informs the Early Warning Score (EWS), which predicts patient deterioration. Nurses’ adherence to monitoring guidelines may influence the accuracy of EWS. Aim: To examine nurses’ adherence to vital signs monitoring and its association with early warning score accuracy. Methods: A study, a descriptive and correlational one, was done, involving a hundred registered nurses in the medical and surgical sections of some hospitals which were chosen. The nurses filled in the V-Scale form to show how much nurses followed the guidelines in five areas: how much work nurses had, what they knew, how nurses talked with others, the tech they used, and what the important signs were. How right the EWS was, was checked by going back over the scores in the hospitals’ computer systems and seeing how nurses matched the scores nurses had written down. Results: The majority of nurses had a fair amount of compliance in every area checked – the average results being from 2.94 to 3.14. Nurses were most compliant when it came to communication, at 3.14, and important measures, at 3.08, but least compliant in the areas of technology, 2.94, and understanding, 2.96. Just 31% of nurses put down a correct EWS. Compliance with workload was clearly linked to a correct EWS (χ² = 7.468, p = 0.024; r = -0.269, p = 0.007), however understanding, communication, technology, and important measures had no notable connection to how right the EWS was. Conclusion: The accuracy of the early warning system depends on how nurses manage their workloads. Recommendations: The study recommends reducing workloads and providing support to nurses, which in turn will contribute to optimizing patient vital signs monitoring and thus enhancing patient safety.
Adherence, Early Warning Score, Monitoring, Nurses, Vital Signs.
Abdullah Ghlaifis Al-Otaibi, Naif Abdulaziz Al-Mutairi, Nawaf Falih Al-Mutairi, Nader Abdulaziz Al-Mutairi
Artificial Intelligence-Assisted Three-Dimensional Morphometric Analysis of Lumbar Vertebral Canal and Pedicle Parameters in Indian Adults Using Computed Tomography
Background: Anatomy research is increasingly moving from traditional descriptive cadaveric work to clinically relevant imaging-based morphometric analysis supported by digital tools. Lumbar vertebral and pedicle dimensions are important for spinal instrumentation, minimally invasive fixation, radiological interpretation, and understanding population-specific anatomical variation. Most available morphometric datasets are based on Western populations, small cadaveric samples, or manual measurements. Artificial intelligence-assisted image segmentation and three-dimensional reconstruction may improve anatomical precision and reproducibility, but region-specific evidence remains limited. Aim:To evaluate lumbar vertebral canal and pedicle morphometry in Indian adults using artificial intelligence-assisted computed tomography-based three-dimensional analysis, and to assess sex-wise and vertebral level-wise variation. Materials and Methods:This cross-sectional observational study was designed on archived abdominal or lumbosacral computed tomography scans of 240 Indian adults aged 20–70 years. Cases with congenital vertebral anomalies, fractures, severe deformity, prior spinal surgery, tumour, or destructive pathology were excluded. DICOM data were processed using semi-automated artificial intelligence-assisted segmentation software to reconstruct L1 to L5 vertebrae in three dimensions. The primary parameters included transverse canal diameter, midsagittal canal diameter, pedicle width, pedicle height, pedicle transverse angle, chord length, and vertebral body transverse diameter. Each parameter was measured bilaterally where appropriate. Inter-observer and intra-observer reliability were assessed in a random 15% subset. Statistical analysis included descriptive statistics, independent t test, repeated-measures analysis of variance, and intraclass correlation coefficient. Results:Pedicle width increased progressively from L1 to L5, while pedicle height showed a decreasing trend caudally. Transverse canal diameter was greatest at lower lumbar levels, whereas midsagittal canal diameter demonstrated smaller interlevel variation. Male participants showed significantly larger pedicle width, chord length, and vertebral body transverse diameter than female participants at most lumbar levels. Pedicle transverse angle increased from upper to lower lumbar vertebrae, with the highest values observed at L5. Artificial intelligence-assisted segmentation produced excellent measurement reliability, with intraclass correlation coefficients above 0.90 for major parameters. The findings indicate clear population-specific dimensional patterns relevant to transpedicular screw placement and spinal canal assessment. Conclusion:Artificial intelligence-assisted three-dimensional CT morphometry provides robust and reproducible anatomical data on the lumbar vertebrae. The present study demonstrates significant sex-based and vertebral level-based variation in lumbar canal and pedicle parameters among Indian adults. These findings may support safer implant selection, preoperative planning, and development of population-specific spinal instrumentation guidelines.
Anatomy; Lumbar vertebra; Morphometry; Artificial intelligence; Computed tomography; Pedicle; Indian population.
Dr Md Shafique, Dr. Juli Tudu, Dr Amitav Panigrahi
Evaluation of Power of Intrapartum Ultrasonography to Predict Obstetric Outcomes in Pregnant Women with a Prolonged Second Stage of Delivery
Introduction-Aim: Digital pelvic examination (DPE), which is used to monitor the progression of delivery; has 5 parameters: dilation, effacement, consistency and position of cervix and level-or station, of the fetal head. All these parameters are subjective and unrepeatable. In this study, it was aimed to evaluate the success of using intrapartum ultrasonography (IUSG) in the second stage of delivery to predict the obstetric outcomes. Materials and Methods: 811 pregnant women, aged between 17 and 45 were included in the study. A detailed VM was made to all participants, who reached full cervical opening. After the effacement, position and consistency of the cervix, the level and the position of the fetal head and the state of the membranes were determined, these VE findings were confirmed by intrapartum ultrasonography. IUSG evaluations were performed by translabial and / or suprapubic method. Fetal occiput-spin angle (OSA) was evaluated by the suprapubic method and head-symphysis distance (HSD), head-perineum distance (HPD), head rotation (HR), head direction (HD), progression angle (AoP), progression distance (PD) and pelvic arch angle (PAA) were evaluated by translabial method. DPE and IUSG evaluations of all 810 participants were made by a single observer. Results: A total of 810 participants were included in the study, including 494 primiparas and 316 multiparas; 520 were Turkish, 258 Syrian and 32 Meskhetian. There was no statistically significant difference in the distribution of parity by races or in the rates of delivery types between races. The duration of the second stage of delivery was significantly longer in Turkish and Syrian primiparas and multiparas women who underwent operative delivery (OD), including IVD and CS. In all three races, the most frequent fetal head position was left occiput transverse (LOT), and fetal head position was significantly associated with the type of delivery in primiparas subgroups. Some of the eight intrapartum ultrasonographic parameters we examined were found to have clinical significance in predicting clavicle fracture. HR, HD, PD, and OSA were successful in predicting clavicle fracture in spontaneous vaginal delivery; HR and AoP were successful in predicting clavicle fracture in instrumental vaginal delivery. For spontaneous vaginal delivery, increased HR and PD, and decreased HD and OSA were associated with an increased incidence of clavicle fracture. In instrumental vaginal delivery, increased HR and AoP were observed to be associated with increased clavicle fracture rates. Conclusion: In our study it was concluded that performing IUSG, regardless of DPE, can be very useful in clinical practice. The data obtained through IUSG, especially in the second stage of delivery; enabled visualization of complex positional changes occurring at the fetal head during its progress in the birth canal and made it possible to be a more objective follow-up for delivery process compared to the VM. It is thought that the standardization of the data obtained with ITU and IUSG can provide a clearer illumination of the pathophysiology of abnormal delivery. Thus, especially in complicated by dystocia delivery, clinical advantage can be gained in predicting delivery arrest and operative delivery, and maternal and neonatal adverse outcomes can be prevented during and after the delivery.
Cesarean Delivery, Dystocia, Intrapartum USG, Instrumental Vaginal Delivery, Translabial USG, Vaginal Examination
Dr. Sibel Üstünel Tan, Prof. Dr. Emin Üstünyurt
A Retrospective Study On Diabetes Mellitus, Metformin, And Head And Neck Cancer.
Background-More research was needed to determine whether metformin use could impact the risk of oral cancer. Methods: During 2015-2025, patients with type 2 diabetes mellitus who had recently started taking metformin (n = 288198, “ever users of metformin”) or other antidiabetic medications (n = 16263, “never users of metformin”) were monitored for oral cancer for at least six months until December 31, 2011.Cox regression adjusted for propensity score (PS) or integrated with the inverse probability of treatment weighting (IPTW) using PS was used to evaluate the treatment impact of metformin (forever versus never users, and for tertiles of cumulative length of therapy). Results- There were also 1273 (0.44%) and 119 (0.73%) occurrence cases of cancer of the mouth among ever users and never users, respectively, with rates of 92.7 and 163.6 per 100,000 person-years. A substantially decreased risk was indicated by the overall hazard ratios (95% CIs) [0.584 (0.483-0.707) for the PS-added model and 0.562 (0.465-0.678) for the IPTW approach]. The PS-adjusted hazard ratios (95% confidence intervals) for the first (<21.5 months), second (21.5-45.9 months), and third (>45.9 a period of time tertiles of cumulative time span were 1.403 (1.152-1.708), 0.557 (0.453-0.684), and 0.152 (0.119-0.194) for IPTW. Conclusions- The possibility of developing oral cancer may be considerably decreased by metformin, particularly if the cumulative period exceeds 21.5 months.
oral cancer, diabetes mellitus, metformin.
Microbiological Profile, Virulence Attributes and Antifungal Susceptibility of Vulvovaginal Candidiasis Among Pregnant Women: A Cross-Sectional Study
Background: Vulvovaginal candidiasis (VVC) is one of the most common fungal infections encountered during pregnancy. Hormonal alterations, immunological modulation, and changes in vaginal microenvironment predispose pregnant women to Candida colonization and symptomatic infection. The increasing emergence of non-albicans Candida species and antifungal resistance has posed diagnostic and therapeutic challenges, particularly in pregnancy where treatment options are limited. Aim and Objectives: To determine the prevalence of vulvovaginal candidiasis among pregnant women, identify the species distribution of Candida isolates, evaluate associated risk factors and virulence determinants, and assess antifungal susceptibility patterns. Materials and Methods: This cross-sectional study included 50 pregnant women presenting with symptoms suggestive of VVC at a tertiary care center. High vaginal swabs were collected and processed using standard mycological techniques. Candida isolates were identified to species level. Virulence factors such as biofilm formation and phospholipase activity were assessed. Antifungal susceptibility testing was performed using the CLSI disc diffusion method. Results: Out of 50 pregnant women, 28 (56%) were culture positive for Candida species. Non-albicans Candida (57.1%) predominated over Candida albicans (42.9%). The highest culture positivity was observed in the third trimester. Biofilm production was detected in 71.4% of isolates, while phospholipase activity was observed in 21.4%. Amphotericin-B (96.4%) and voriconazole (85.7%) showed the highest antifungal sensitivity, whereas fluconazole and nystatin demonstrated moderate resistance. Conclusion: Vulvovaginal candidiasis remains highly prevalent among pregnant women, with an emerging dominance of non-albicans Candida species exhibiting significant virulence traits. Routine species identification and antifungal susceptibility testing are essential for optimal management and prevention of recurrent infections during pregnancy.
Vulvovaginal candidiasis, Pregnancy, Candida species, Biofilm, Antifungal susceptibility, Non-albicans Candida
Bacterial Infections and Male Infertility: Exploring the Microbial Spectrum and Its Effects on Semen Parameters
Male infertility is a significant reproductive health issue, with infectious agents playing a crucial role in its pathophysiology. This study aimed to evaluate the microbial profile of bacteria in male infertility patients and their impact on seminal fluid quality. A total of 100 male infertility patients were enrolled, and their semen samples were analyzed for bacterial infections. The most common pathogens identified were Escherichia coli, Enterococcus faecalis, and Staphylococcus aureus. The presence of bacterial pathogens was associated with lower sperm count, motility, and increased abnormal sperm morphology. Additionally, a high antibiotic resistance profile was observed among the isolates. The findings suggest that bacterial infections are a significant contributor to male infertility and highlight the need for proper diagnosis and management of infections in infertile men.
Male infertility, bacterial infections, microbial profile, seminal fluid, antibiotic resistance, sperm quality
Prevalence and Sociodemographic Risk Factors of Human Papillomavirus Infection Among Women Attending A Tertiary Care Centre: A Cross-Sectional Study
Background: Human papillomavirus (HPV) infection is the most common sexually transmitted viral infection worldwide and is strongly associated with cervical cancer and other anogenital malignancies. The burden of HPV infection remains particularly high in developing countries due to limited screening, lack of awareness, and poor vaccination coverage. Understanding the epidemiological and sociodemographic determinants of HPV infection is essential for developing targeted preventive strategies. Aim: To determine the prevalence of HPV infection and evaluate the sociodemographic risk factors associated with HPV among women attending a tertiary care centre. Materials and Methods: A hospital-based cross-sectional study was conducted among 100 women aged 21–65 years attending the gynecology outpatient department of a tertiary care hospital. Cervical samples were collected using sterile cervical brushes and preserved in transport medium. HPV DNA detection and genotyping were performed. Sociodemographic parameters such as age, occupation, education level, socioeconomic status, and residence were analyzed to determine their association with HPV infection. Results: Out of 100 women screened, 23 were HPV positive, giving an overall prevalence of 23%. The highest prevalence was observed in women aged 21–30 years (35%). HPV infection was more common among housewives (23.08%), illiterate women (50%), low-income groups (25%), and rural residents (26.15%). Educational status and residence showed strong associations with HPV prevalence. Conclusion: HPV infection remains a significant public health concern, particularly among women from rural and lower socioeconomic backgrounds. Increasing awareness, improving cervical cancer screening programs, and expanding HPV vaccination coverage are essential to reduce HPV-associated morbidity and mortality.
Human papillomavirus, Cervical cancer, PCR, Prevalence, Sociodemographic factors, Rural population
Clinical and Etiological Profile of Acute Febrile Illness in Children Attending a Tertiary Care Hospital
Background: Acute febrile illness (AFI) is a leading cause of pediatric visits and admissions worldwide. The nonspecific presentation of AFI and broad etiological spectrum present diagnostic and therapeutic challenges, particularly in low- and middle-income countries. Objective: To describe the clinical features, laboratory profile, etiological distribution, complications and outcomes of children presenting with acute febrile illness to a tertiary care hospital. Methods: Hospital-based observational study including children aged 1 month–14 years with fever ≤14 days (n = 100). Standardized history, physical exam, and investigations (CBC, peripheral smear, CRP, urine analysis, blood culture, disease-specific tests such as dengue NS1/IgM, malaria antigen/smear, Widal, scrub typhus IgM) were performed. Data were tabulated and analyzed descriptively. Results: Among 100 children, median age distribution showed predominance in 1–5 years (36%) with male:female = 56:44. Common symptoms included vomiting (48%), cough (42%), and headache (34%). Etiologies identified: viral fever (34%), dengue (18%), enteric fever (12%), malaria (10%), bacterial sepsis (8%), UTI (8%), pneumonia (6%), scrub typhus (4%). Complications occurred in 30% (shock 8%, bleeding 10%, seizures 6%), mortality 2%. Median hospital stay was 4–7 days in 46%. Conclusions: Viral illnesses remain the most frequent cause of AFI, but dengue, enteric fever, malaria, and bacterial infections are important contributors. A protocolized approach with region-specific diagnostic testing improves etiological yield and guides management.
Acute Febrile Illness, Children, Etiology, Dengue, Enteric Fever, Scrub Typhus, Tertiary Care
Epidemiology, Management, and Outcomes of Infective Endocarditis: A Retrospective Analysis of Patients
Background: Infective endocarditis (IE) remains a serious and often fatal disease affecting both native and prosthetic heart valves. Despite advances in diagnosis and treatment, the prognosis for patients with IE varies widely depending on numerous factors, including the causative microorganism, the presence of valvular damage, and the promptness of therapeutic intervention. Objective: The aim of this study was to investigate the clinical, microbiological, and echocardiographic features of IE in a cohort of 75 patients, with an emphasis on the impact of microbial pathogens on outcomes, the role of echocardiographic findings, and the effectiveness of medical and surgical interventions. Methods: This retrospective study included 75 patients diagnosed with IE according to the modified Duke criteria. We analyzed demographic characteristics, microbiological profiles, echocardiographic findings, clinical outcomes, and complications. A comprehensive statistical analysis was performed to assess the relationships between these variables and patient prognosis. Results: The study population consisted predominantly of male patients (66.7%), with a mean age of 45 years. Native valve endocarditis was observed in 72.0% of patients, and Staphylococcus aureus was the most common pathogen isolated (35.2%). Echocardiographic findings indicated vegetation in 84.0% of cases, with severe valvular regurgitation in 32.0%. The overall in-hospital mortality rate was 16.0%, with heart failure (34.7%) and systemic embolization (24.0%) being the most frequent complications. Conclusion: This study underscores the persistent challenges posed by IE, particularly the significant role of Staphylococcus aureus in the pathogenesis of the disease and the common occurrence of severe valvular damage. The findings emphasize the need for timely and aggressive intervention to improve outcomes in these patients.
Epidemiology and Clinical Characteristics of Dengue: A Study on Prevalence, Demographics, and Seasonal Variation
Dengue fever, a mosquito-borne viral disease, continues to pose significant public health challenges, particularly in tropical and subtropical regions. Despite ongoing prevention efforts, the global incidence of dengue has increased in recent years, with outbreaks occurring more frequently in both urban and rural areas. This study aims to examine the prevalence of dengue, focusing on demographic variables such as age, gender, and geographic distribution, along with seasonal patterns and clinical manifestations. A total of 2,000 dengue cases were analyzed, with findings showing that the highest number of cases occurred in individuals aged 10-20 years, and that males were more frequently affected than females. Urban areas accounted for 70% of the total cases, with the majority of cases observed during the wet season, highlighting the role of climatic conditions in transmission. Clinical symptoms included fever (100%), rash (70%), joint pain (60%), and headache (75%). Severe forms of dengue, such as dengue hemorrhagic fever (DHF) and dengue shock syndrome (DSS), were observed in 10% of cases, with bleeding being the most common severe symptom. These results underscore the need for targeted mosquito control programs, early diagnosis, and effective clinical management to mitigate the growing burden of dengue. The study’s findings contribute to a better understanding of the epidemiological trends and clinical features of dengue, which are essential for designing more effective public health strategies.
Dengue fever, dengue virus, Aedes mosquitoes, vector-borne disease, seasonal variation, clinical manifestations, dengue hemorrhagic fever, dengue shock syndrome,
A Study On The Prevalence and Antibiotic Resistance Patterns of Pseudomonas Aeruginosa Isolates in Chronic Suppurative Otitis Media
Introduction: CSOM is often associated with recurrent infections, leading to permanent damage to the ear structures. While the pathogenesis of CSOM is complex and multifactorial, bacterial infections play a major role, with Pseudomonas aeruginosa emerging as one of the most frequent pathogens responsible for this condition Objective: This study aims to determine the prevalence of Pseudomonas aeruginosa isolates in patients with chronic suppurative otitis media (CSOM) and to evaluate the antibiotic resistance patterns of these isolates, with a specific focus on imipenem resistance. Methods: A retrospective study was conducted on 60 patients diagnosed with CSOM at a tertiary care hospital. Ear swab samples were collected and cultured for bacterial isolation. The isolates were identified, and antibiotic susceptibility testing was performed using the disk diffusion method to assess resistance, especially to imipenem. Results: Out of the 60 CSOM-positive cases, 44% were infected with Pseudomonas aeruginosa. The majority of isolates were Gram-negative bacteria (78%), with Pseudomonas aeruginosa being the most prevalent. Of the 26 Pseudomonas aeruginosa isolates, 42.3% showed resistance to imipenem. Other significant pathogens included Klebsiella spp. and Escherichia coli. Resistance to multiple antibiotics, including imipenem, was observed, underscoring the challenge of treating CSOM infections effectively. Conclusion: Pseudomonas aeruginosa is a significant pathogen in CSOM, with a high rate of imipenem resistance. The study highlights the importance of regular bacterial cultures and antibiotic susceptibility testing for the proper management of CSOM and the need for strict antibiotic stewardship programs to combat resistance.
Chronic Suppurative Otitis Media, Pseudomonas aeruginosa, Antibiotic Resistance, Imipenem, Gram-negative Bacteria, Otitis Media, Culture, Antibiotic Susceptibility Testing.
TO STUDY THE MICROBIOLOGICAL PROFILE OF SURGICAL SITE INFECTIONS IN POST OPERATIVE PATIENTS AT A TERTIARY CARE CENTRE, UTTAR PRADESH, INDIA
Introduction:The problem of surgical site in fection(SSI),which contributesto significant morbidity and death, lengthens hospital stays, and ultimately raises healthcare expenditures, is still widespreadand common. Aim and Objectives: To study themicrobiological profile of surgical site infections in post operative patients at a tertiary care centre, Uttar Pradesh, India. Material and Methods: This was a Cross-sectional study conducted in a hospital setting over theperiod of 1 year 6 Monthi.e,, October 2022 to April 2024 at a Rama Medical College Hospital & Research Centre. All surgically treated patientsofbothsexeswereincluded.Patientswhoreceivedasecondsurgeryatthesamelocationforanyreason,patientsreceivingimmunosuppressantmedication,peoplewith immunodeficiency diseases, people currently taking antibiotics, and people with infectionselsewherewereallexcluded fromparticipating.Iftherewassignsofawoundinfection48hours after surgery, the patient was diagnosed with SSI. Suitable statistical analysis was carried out to analyse the data. Results: A total no. of 99 patients underwent different types of surgeries. Out of 99 sample 52were observed to be culture positive. Among the 52 culture positivecases Gram positive bacteria was most common isolated32(32.2%) other than Gram negative bacteria 20(20.2%).The positive casesof MSSA was found to be (26.9%), CONS (17.3%), MRSA (11.5%)whereas in case of GNB,Klebsiellaoxytocaand Pseudomonas aeruginosawas found to be(9.6%), Klebsiella pneumoniae(7.6%)followed byE.coli,Proteus mirabiliswith (3.8%), and least for Staphylococcus epidermitidis , Staphylococcus lugdinensis , Citrobacter, Enterobacter and MRCONSwith (1.92%). It was observed that the site of the infection most common affected was the superficial site with (81.2%) Conclusion: Abdominal surgeries were more likely to result in SSIs. After any type of surgery, patients who were male, with the age group of 30 years or above , had emergency surgery, had diabetes, and/or have had a lengthy hospital stay are more likely to develop SSIs.The increasing occurrence among male was attribute to the nature of the infected wounds which they come to surgical department.
Surgical site infection, Prevalence, Microorganisms, Hospital stay
Cognitive Abilities of the Asian Elephant: A Comprehensive Zoological Study.
Animal cognition research has expanded significantly over the past forty years, primarily focusing on lab animals with varying cognitive abilities, such as rodents, birds, and primates. Despite their reputation as highly social, cooperative, and intelligent animals, elephants have received surprisingly little direct cognitive research, aside from long-term behavioral studies in the wild. Both Asian (Elephas maximus) and African (Loxodonta africana or L. cyclotis) elephants have been notably underrepresented in cognitive research. This paper discusses the potential and justification for investigating elephant cognition within zoological settings and reviews recent advancements in this area, including our latest study on mirror self-recognition in elephants.
Cognition, psychology, zoology, elephant, behavioral study, self recognition, Elephas Maximus, intelligent animal.
The Impact of Exercise Training on Biomarkers, Altered Renin-Angiotensin-Aldosterone System (RAAS) in Diabetic Nephropathy Individuals
Objective: Diabetes mellitus is a major cause of metabolic and systemic diseases contributing mainly for kidney and cardiovascular anomalies all around the world. To manage such untoward outcomes, in addition to medications, the present study aims to assess productive effects of exercise on Renin-Angiotensin-Aldosterone System (RAAS), biomarkers, related albuminuria, estimated glomerular filtration rate (eGFR) and clinical factors. Methods: A prospective, cohort-controlled experiment was conducted. Confirmed cases (n = 150) either gender of diabetes with underlying chronic kidney disease (CKD) and diabetic nephropathy (DN) with aged 35-45 were selected, divided into 3 groups each with no exercise, 3 months and 6-month exercise, respectively. Exercise regiments were prescribed and blood was collected at the end of each periodic end. Blood was analyzed for Renin, Angiotensin II, biomarkers, parathyroid hormone (PTH), lactate, insulin and fasting glucose according to standard procedures on Roche Cobas c503, e801, e411, Snibe X800 and NOVA PHOX plus. Results: Statistically analyzed data exhibited potentiating effects of exercise. Renin, Aldosterone, PTH and PCO2, predicated significance betterment only after 6 months of exercise whereas Angiotensin II, Lactate, PCO2, PO2, Urine albumin and glomerular filtration rate (GFR) exhibited moderate to marked/highly significant changes both after 3 months and after 6 months of exercise. Conclusion: It has been concluded, in addition to all traditional treatments and medications, long term exercise does have benefits in the betterment of diabetic patients with underlying DN and thus be encouraged to be part of every treatment plans based on individuals’ specifications.
Chronic kidney disease, Diabetic Nephropathy, End stage renal disease, Glomerular filtration rate, Renin Angiotensin Aldosterone system.
Humayun Imran Azeemi, Basit Ansari, Saeed Akhter, Shah Ali Ul Qader
Efficacy Comparison of Sodium-Glucose Cotransporter-2 Inhibitors, Glucagon-Like Peptide-1 Receptor Agonists, and Dipeptidyl Peptidase-4 Inhibitors in Heart Failure with Preserved Ejection Fraction: A Systematic Review And Network Meta-Analysis
Background: Heart failure with preserved ejection fraction (HFpEF) represents a major unmet therapeutic need with limited evidence-based pharmacologic options. Sodium-glucose cotransporter-2 inhibitors (SGLT2i) have demonstrated benefit, while the roles of glucagon-like peptide-1 receptor agonists (GLP-1 RA) and dipeptidyl peptidase-4 inhibitors (DPP-4i) remain less clear. A direct and indirect comparison of these antihyperglycemic drug classes on cardiovascular outcomes in HFpEF is required. Methods: We conducted a systematic review and network meta-analysis (NMA) of randomized controlled trials (RCTs). Databases (MEDLINE, Embase, Scopus, Web of Science, CENTRAL, were searched from inception to 2024-10-27. RCTs enrolling adults with HFpEF (LVEF ≥40%) comparing an SGLT2i, GLP-1 RA, or DPP-4i against placebo or active control were included. Primary outcomes were a composite of first hospitalization for heart failure (HHF) or cardiovascular (CV) death, and total HHF events. Secondary outcomes included CV death, all-cause death, and Kansas City Cardiomyopathy Questionnaire (KCCQ) score change. Data were pooled using frequentist random-effects NMA, with ranking via P-scores. Risk of bias was assessed using Cochrane RoB 2. Results: From 5,317 records, 12 RCTs (n=25,147 participants) were included. For the composite of HHF/CV death, SGLT2i significantly reduced risk compared to placebo (hazard ratio [HR] 0.80, 95% CI 0.73–0.88) and were superior to both DPP-4i (HR 0.77, 95% CI 0.66–0.89) and GLP-1 RA (HR 0.84, 95% CI 0.72–0.99). GLP-1 RA showed a non-significant trend towards benefit versus placebo (HR 0.94, 95% CI 0.81–1.10). DPP-4i did not differ from placebo (HR 1.03, 95% CI 0.89–1.20). For total HHF, SGLT2i were superior to all comparators. SGLT2i also ranked highest for improving KCCQ total symptom score. No significant difference was observed between drug classes for CV or all-cause mortality. Conclusion: In patients with HFpEF, SGLT2i provide the most robust reduction in heart failure events and improvement in health status compared to GLP-1 RA, DPP-4i, and placebo. GLP-1 RA show a neutral effect on primary HFpEF outcomes, while DPP-4i should not be used for HFpEF management. These findings strongly support the preferential use of SGLT2i in the HFpEF population.
Heart failure with preserved ejection fraction, SGLT2 inhibitors, GLP-1 receptor agonists, DPP-4 inhibitors, Network meta-analysis.
Dr Mohd Fazal Ahmed Makki, Dr. Farah Kausar, Dr. Pushkar Mani, Dr Manisa Mohanty
Assessment of knowledge and attitude of mothers of children admitted with jaundice in a tertiary care hospital in Bangladesh
Background: Jaundice is a common clinical condition marked by yellow discoloration of the skin and sclera due to bilirubin accumulation. It results from various hepatic, biliary, or hemolytic disorders. In Bangladesh, viral hepatitis, particularly Hepatitis B infection, is a major cause. Beyond medical issues, jaundice is often linked to social stigma, misconceptions, and psychological distress. Studies in other countries show negative public attitudes and poor awareness about jaundice. However, limited data exist in Bangladesh regarding community perceptions. This study was therefore conducted to assess the knowledge and attitude of mothers of children admitted with jaundice, aiming to identify gaps and guide future health education efforts. Methods: This cross-sectional study was conducted in the Department of Pediatrics, North East Medical College Hospital, Sylhet, from June 2024 to June 2025. Mothers of children admitted with jaundice were interviewed using a predesigned structured questionnaire covering sociodemographic information, knowledge, and attitudes toward childhood jaundice. Trained physicians conducted the interviews to ensure accuracy. Data were analyzed using SPSS version 20. Continuous variables were summarized as mean ± standard deviation, and categorical variables as frequencies and percentages. Results were presented in tables and figures for clarity. Results: Among 46 mothers, most were aged 21–30 years (78.3%), educated (76.1%), and from joint families (76.1%). While 95.3% had heard of jaundice, only 54.3% recognized yellow skin/eyes as a symptom, and knowledge of causes, complications, and treatment was limited. Phototherapy and modern medicine were known to 63% and 52.2%, respectively. Regarding attitude, 39.1% considered jaundice transmissible, 34.8% were willing to work with patients, 54.3% supported school/work attendance, and 67.4% opposed marriage. Most (65.2%) preferred modern treatment. Overall, awareness was high but knowledge and attitudes were incomplete. Conclusion: Mothers’ knowledge and attitudes are crucial for early recognition, timely treatment, and prevention of childhood jaundice complications. Misconceptions can delay care, highlighting the need for targeted education on causes, warning signs, and preventive measures. Structured counseling and community awareness programs can improve maternal understanding, treatment adherence, and child health outcomes.
Jaundice, Tertiary care hospital, knowledge, Attitude
Shohely Parveen, Ridwanul Islam, Jesmeen Morshed, Shariful Hasan, Mohammad Asadur Rahman, Mohammad Shoaib Chowdhury, Zahidur Rahman
Clinical Outcomes of Cervical Cancer Patients Treated with Surgery and Concurrent Chemoradiation Therapy in CMH, Dhaka
Background: Cervical cancer is a leading cause of cancer-related death among women, particularly in developing countries. Early-stage disease can often be cured with surgery or chemoradiotherapy, while advanced stages require combined treatment approaches. Outcomes vary depending on disease characteristics, patient factors, and healthcare resources. Limited data exist in Bangladesh regarding treatment responses, survival, and complications. This study aims to evaluate the clinical outcomes of cervical cancer patients undergoing radical hysterectomy and chemoradiation therapy in a tertiary care military hospital. Methods: This retrospective cohort study at Combined Military Hospital, Dhaka, Bangladesh (2015–2022) included 192 cervical cancer patients treated with radical hysterectomy, concurrent chemoradiation, or both. Data on demographics, tumor characteristics, treatment, and follow-up outcomes were collected. Primary outcomes were 5-year overall and disease-free survival, while secondary outcomes included recurrence and post-treatment complications. Survival and recurrence analyses were performed using chi-square tests and Cox regression, with p < 0.05 considered significant. Results: Among 192 cervical cancer patients, most were middle-aged with squamous cell carcinoma and stage II disease. Treatments included surgery, CCRT, or both, with 35% experiencing complications. Five-year survival was 71.9%, highest after surgery alone, and recurrence occurred in 18%, with advanced stage, adenocarcinoma, and positive lymph nodes predicting higher risk. Conclusion: Survival and recurrence in cervical cancer are strongly influenced by disease stage and treatment type. Surgery is most effective in early stages, while CCRT is essential for advanced disease. Delayed detection highlights the need for early screening, HPV vaccination, multidisciplinary care, and a national cancer registry in Bangladesh.
Cervical cancer, chemoradiation, radical hysterectomy, survival outcomes, recurrence, HPV vaccination, Early detection.
Nazma Siddiquee, SM Rokonuzzaman, Shamima Yasmin, Farhana Jannat, Reshma Sharmin
Successful Resuscitation Following Aluminum Phosphide (Celphos) Poisoning Complicated by Ventricular Tachycardia and Cardiogenic Shock: A Case Report
Background: Aluminum Phosphide Poisoning is a highly lethal form of pesticide poisoning commonly seen in developing countries. It leads to severe metabolic toxicity, refractory shock, malignant arrhythmias, and high mortality. Survival following cardiac arrest is rare. Case Presentation: We report a case of a 30-year-old male who presented with aluminum phosphide ingestion, severe hypotension, and altered sensorium. During hospitalization, the patient developed pulseless ventricular tachycardia requiring cardiopulmonary resuscitation and defibrillation. With aggressive intensive care management including ventilatory support, vasopressors, and supportive therapy, the patient survived and was discharged in stable condition. Conclusion: Early aggressive resuscitation, timely defibrillation, and multidisciplinary critical care support can improve survival in severe aluminum phosphide poisoning complicated by cardiac arrest.
A Comparative Study of Attenuation of Hemodynamic Responses During Tracheal Extubation with Intravenous Magnesium Sulphate and Intravenous Esmolol in Surgeries Under General Anaesthesia
Background: Tracheal extubation is frequently associated with undesirable hemodynamic responses such as tachycardia and hypertension due to sympathetic stimulation. These responses may be detrimental in patients with cardiovascular or cerebrovascular compromise. Various pharmacological agents have been evaluated to attenuate these responses, among which magnesium sulphate and esmolol have shown promising results. Aim: To compare the efficacy of intravenous magnesium sulphate and intravenous esmolol in attenuating hemodynamic responses during tracheal extubation in patients undergoing surgeries under general anaesthesia. Materials and Methods: This prospective, randomized comparative study was conducted on 85 patients aged 18–60 years, classified as ASA physical status I and II, undergoing elective surgeries under general anaesthesia. Patients were randomly allocated into two groups: Group M (magnesium sulphate) and Group E (esmolol). Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, at extubation, and at 1, 3, and 5 minutes after extubation. Data were analyzed using appropriate statistical tests. Results: Both drugs attenuated the hemodynamic response during extubation; however, magnesium sulphate was significantly more effective than esmolol in controlling heart rate and blood pressure at extubation and in the immediate post-extubation period (p < 0.05). Conclusion: Intravenous magnesium sulphate provides superior attenuation of hemodynamic responses during tracheal extubation compared to intravenous esmolol, with minimal adverse effects.
Tracheal extubation; Hemodynamic response; Magnesium sulphate; Esmolol; General anaesthesia
Dr. Narendra Singh Bafila, Dr. Deepak Yadava, Dr. Rachna Verma , Dr. Chaitra S, Dr. Sanni Deyol Gautam
Comparative Efficacy of Preoperative Nebulized Dexmedetomidine, Ketamine, and Magnesium Sulphate in Preventing Postoperative Sore Throat after Laparoscopic Surgery under General Anaesthesia
Background: Postoperative sore throat (POST) is a frequent and distressing complication after tracheal intubation for general anesthesia, with reported incidence varying widely depending on definitions and populations. Pharmacologic nebulization prior to induction is an attractive, low-risk, topical approach to reduce mucosal inflammation and nociception. Objective: To evaluate and compare the efficacy of preoperative nebulized dexmedetomidine, ketamine, and magnesium sulphate in preventing POST in adult patients undergoing elective laparoscopic surgery under general anesthesia. Methods: This randomized, double-blind, three-arm study included 50 adult patients allocated to receive preoperative nebulization 30 minutes before induction: Group D (dexmedetomidine 1 µg/kg diluted to 4–5 mL, n = 17), Group K (ketamine 50 mg diluted to 4–5 mL, n = 17), and Group M (magnesium sulphate 250 mg diluted to 4–5 mL, n = 16). Standardized anesthesia, cuff pressure control (20–25 cmH₂O), and endotracheal tube sizes were used. Primary outcome: incidence of POST at 6 hours post-extubation. Secondary outcomes: incidence at 0, 2, 12, 24 h; severity (4-point scale), hoarseness, cough, sedation, and adverse events. Analysis followed intention-to-treat principles. Results: Overall, dexmedetomidine showed the lowest incidence of POST at all time points and was significantly superior at the primary endpoint (6 h): 1/17 (5.9%) in Group D vs 4/17 (23.5%) in Group K and 5/16 (31.3%) in Group M (p = 0.04). Severity of POST was predominantly mild and no severe events occurred. Sedation (transient, mild) and two episodes of bradycardia occurred in Group D; no serious adverse events were recorded. Conclusion: In this 50-patient randomized comparison, preoperative nebulized dexmedetomidine (1 µg/kg) produced a clinically meaningful reduction in incidence and severity of POST compared with nebulized ketamine (50 mg) and nebulized magnesium sulphate (250 mg), with an acceptable safety profile. Larger multicenter trials are warranted to confirm these findings and to refine optimal dosing and timing. Background: Postoperative sore throat (POST) is a frequent and distressing complication after tracheal intubation for general anesthesia, with reported incidence varying widely depending on definitions and populations. Pharmacologic nebulization prior to induction is an attractive, low-risk, topical approach to reduce mucosal inflammation and nociception. Objective: To evaluate and compare the efficacy of preoperative nebulized dexmedetomidine, ketamine, and magnesium sulphate in preventing POST in adult patients undergoing elective laparoscopic surgery under general anesthesia. Methods: This randomized, double-blind, three-arm study included 50 adult patients allocated to receive preoperative nebulization 30 minutes before induction: Group D (dexmedetomidine 1 µg/kg diluted to 4–5 mL, n = 17), Group K (ketamine 50 mg diluted to 4–5 mL, n = 17), and Group M (magnesium sulphate 250 mg diluted to 4–5 mL, n = 16). Standardized anesthesia, cuff pressure control (20–25 cmH₂O), and endotracheal tube sizes were used. Primary outcome: incidence of POST at 6 hours post-extubation. Secondary outcomes: incidence at 0, 2, 12, 24 h; severity (4-point scale), hoarseness, cough, sedation, and adverse events. Analysis followed intention-to-treat principles. Results: Overall, dexmedetomidine showed the lowest incidence of POST at all time points and was significantly superior at the primary endpoint (6 h): 1/17 (5.9%) in Group D vs 4/17 (23.5%) in Group K and 5/16 (31.3%) in Group M (p = 0.04). Severity of POST was predominantly mild and no severe events occurred. Sedation (transient, mild) and two episodes of bradycardia occurred in Group D; no serious adverse events were recorded. Conclusion: In this 50-patient randomized comparison, preoperative nebulized dexmedetomidine (1 µg/kg) produced a clinically meaningful reduction in incidence and severity of POST compared with nebulized ketamine (50 mg) and nebulized magnesium sulphate (250 mg), with an acceptable safety profile. Larger multicenter trials are warranted to confirm these findings and to refine optimal dosing and timing.
Postoperative Sore Throat; Nebulization; Dexmedetomidine; Ketamine; Magnesium Sulphate; Laparoscopic Surgery.
Dr. Shruti Tripathi, Dr. Vinamra Tiwari, Dr. H N Madhusudana, Dr. Mohammad Ali, Dr. Sushil Ambesh