Central India Journal of Medical Research
Central India Journal of Medical Research (CIJMR) (ISSN-2583-6609) is an official publication of Ruxmaniben Deepchand Gardi Medical College (RDGMC) and MRI Publication Pvt. Ltd. Central India Journal of Medical Research's publication frequency is tri-annual. The first issue of CIJMR was published in Jun 2022. CIJMR publishes articles in English language. Ujjain has been a seat of learning since time immemorial. Its history dates back to the era of Lord Krishna, who underwent his education at Sant Sandipani’s Ashram situated on the banks of river Kshipra. Inspired by its rich educational heritage, a dedicated team of trustees envisioned the potential to provide medical education and services, and thus the first-ever private medical college of the state of Madhya Pradesh; the Ruxmaniben Deepchand Gardi Medical College (RDGMC) came into existence in the year 2001 under the banner of Ujjain Charitable Trust and Research Centre. RDGMC is recognized by the Medical Council of India and Ministry of Health & Family Welfare, Govt. of India and is affiliated to Madhya Pradesh Medical Science University (MPMSU), Jabalpur. RDGMC provides undergraduate and postgraduate medical education in different specialties since 2009. There are 110 MCI recognized PG seats on the date. Our aim is to provide best medical education to students, expose them to renowned national and international faculty, motivate them for research and make them competent clinicians who can meet the challenge of treatment in the remotest village of India as well as the most advanced hospital anywhere in the world. Noble Research, Global Impact
Ruxmaniben Deepchand Gardi Medical College
Heat Exposure in Pregnancy: A Global Threat with Unequal Consequences
Copyright (c) 2026 Manju Purohit, Weirong Yan, Shweta Khare https://creativecommons.org/licenses/by-sa/4.0
Assessment of Antihypertensive Medication Adherence in a Rural Indian Population
Background: Hypertension is a leading non-communicable disease and a major contributor to cardiovascular morbidity and mortality in India. Medication adherence plays a crucial role in achieving optimal blood pressure control; however, adherence remains suboptimal, particularly in rural populations due to various socioeconomic and healthcare-related barriers. This study aimed to assess antihypertensive medication adherence and identify factors associated with adherence in a rural population. Methods: A community-based cross-sectional study was conducted among 366 hypertensive patients aged ≥18 years residing in the rural locality around the Primary Health Center of Medavakkam, Chennai. Participants with a diagnosis of hypertension for more than one year were included. Medication adherence was assessed using the Morisky Medication Adherence Scale-8 (MMAS-8). Sociodemographic and clinical data were collected through door-to-door surveys using a structured questionnaire. Data were analyzed using SPSS version 24. Descriptive statistics were used to summarize variables, and the Chi-square test and ANOVA were applied to assess associations between adherence and independent variables. A p-value <0.05 was considered statistically significant. Results: Among the 366 participants, 28.1% demonstrated high adherence, 50.5% showed medium adherence, and 21.3% had low adherence to antihypertensive medication. Female participants exhibited significantly higher adherence compared to males (p = 0.01). Patients receiving fewer antihypertensive medications had better adherence than those on multiple medications (p = 0.04). Age showed a borderline association with adherence (p = 0.07), while education level, occupation, and duration of hypertension were not significantly associated with adherence. Conclusion: The study found that a substantial proportion of hypertensive patients in this rural population exhibited only moderate adherence to antihypertensive therapy. Gender and medication regimen complexity were significant determinants of adherence. These findings highlight the need for targeted interventions such as patient education, simplified treatment regimens, and community-based strategies to improve medication adherence and strengthen hypertension management in rural settings.
Copyright (c) 2026 Princy Felicia, Sahasyaa Adalarasan, Gertrude Banumathi https://creativecommons.org/licenses/by-sa/4.0
Determining causes of AUB by Clinical Diagnosis, SIS & Ultrasound Findings to Assertain PALM COEIN Status for Planning Line of Management
Introduction: Abnormal uterine bleeding (AUB) affects about 14 to 25% of the population, with a prevalence of 17.9% in India. This condition poses an intricate gynaecological challenge for women. Across all age groups, varied diagnostic approaches are available, viz., History taking, Ultrasound examination, Saline infusion sonography with or without 3D, Hysteroscopy, MRI imaging, CT scan, and so on. All these help us ascertain the PALM COEIN of the underlying pathology. (PALM: Polyp, Adenomyosis, Leiomyoma, Malignancy) (COEIN: Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, Not classified). This study aims to investigate the causes of menorrhagia to improve patient management according to the PALM-COEIN classification developed by the International Federation of Gynaecology and Obstetrics (FIGO). Materials and Methods: A prospective observational study was conducted over one year at Ruxmaniben Deepchand Gardi Medical College, Ujjain, involving 151 women aged 18 to 65 years with AUB. Participants underwent comprehensive assessments, including menstrual history review, physical examinations, transvaginal ultrasound, and saline infusion sonography (SIS), with histopathological analysis performed on tissue samples. Results: The majority of participants (48.3%) were aged 40 to 49, with 90.7% from rural areas and predominantly employed in farming (42.4%). Heavy menstrual bleeding was the most prevalent symptom (45%). Ultrasound detected normal findings in 50.3% of cases, whereas SIS revealed normal findings in 41.7%. Histological findings showed normal results in 47%, while SIS demonstrated superior diagnostic performance for detecting polyps (AUC: 0.970) and endometrial hyperplasia (AUC: 0.917) compared to transvaginal ultrasound. Conclusion: This study highlights the superior diagnostic accuracy of SIS over ultrasound in identifying uterine pathologies associated with AUB. SIS (Saline Infusion Sonography) provides greater sensitivity and specificity, identifying key etiological factors such as polyps, submucosal fibroids, and endometrial hyperplasia. These findings propose that SIS can enhance patient management strategies and improve treatment outcomes, ultimately preserving uterine health.
Copyright (c) 2026 Pulak Roy, Dr. Deepika Jain, Dr Shalini Srivastava, Dr Shaline Agrawal https://creativecommons.org/licenses/by-sa/4.0
Spirometry: An Interpretation of Patterns and Clinical Implications
Introduction: In general practice spirometry is under utilized in the diagnosis of the common respiratory symptom like breathlessness. A standardized forcible expiratory blow inside the spirometry machine followed by a force inspiratory maneuver displays various data related to flow of air in the lungs in the form of a flow-volume loop and volume-time tracings. A valid reporting as per ATS criteria is prerequisite for the interpretation and then compared with a predicted values of an individual. Results: The main four parameters FVC, FEV1, ratio of FEV1/FVC and peak expiratory flow (PEF) are studied in patients to categorized them in various patterns; e.g. A) Normal pattern (40%), B) Obstructive flow pattern (15%); C) Restrictive (1%); D) Mixed pattern (28%); E) Obstructive (3%); and F) Mixed pattern (13%) with dominant obstructive/pseudo restrictive. A significant BD effect was observed in 28% (32/115) participants with having normal spirometry, while 40% (70/175) BD effect was observed among abnormal spirometry patterns. A low CPF was detected in 91(31%) of case and similarly, a value of less than 1L/sec PIFR was observed in 23 (8%) cases and thus not suitable for the DPI device. An overall restrictive PRISM in 11(4%), obstructive PRISM in 61 (21%) cases were also detected. Discussion: Once the basic four parameters were identified and grouped together in various patterns, it becomes easy to understand the underlying ailment. These patterns enable differential diagnosis and help to customize management. The BD therapy could be planned and given to all who had produced a significant or partial response. A PIFR value of more than 1 liter/second would be required for the dry powder inhaler (DPI); otherwise, a device like MDI with a spacer or nebulizer should be preferred. Similarly, a normal adult should have more than 4L/Sec of PEFR, which is sufficient to clear the secretion as cough peak flow (CPF). Broadly a breathing exercises for the restrictive disorders, diaphragmatic and purse lip breathing for the obstructive pattern is recommended with periodic reassessment with spirometry. An additional detection of PRISM (preserved ratio impaired spirometry) cases could advise preventive measures, e.g., smoking cessation, etc., to minimize the risk of future disease load. Conclusion: Spirometry is an important tool in evaluating shortness of breath and other respiratory symptoms which could be due to neuromuscular, pleural, parenchymal, and small or large airways abnormalities. It has a crucial role in differential diagnosis and dynamic volumetric assessment of a forceful expirational and inspirational activities. A newer version of spirometry or advanced technology equipment like FENO and oscillometry have become widely acceptable as thet are free from strict forceful maneuver (e.g. easy usual breath suitable for children and ICU patient), they are handy and cost effective and serve as alternate future modality.
Copyright (c) 2026 jagdish agrawat, Arti Julka, Singapurwala M, Jitendra Punase https://creativecommons.org/licenses/by-sa/4.0
Prevalence and Pattern of Thyroid Dysfunction in Newly Detected Type 2 Diabetes Mellitus Patients at a Tertiary Care Centre
Background: Thyroid dysfunction (TD) and type 2 diabetes mellitus (T2DM) commonly coexist and influence each other’s clinical course. This study describes the prevalence and pattern of TD among newly diagnosed T2DM patients at a tertiary care centre. Methods: Hospital-based cross-sectional observational study of 100 newly diagnosed T2DM patients (October 2022–September 2023). Thyroid function was measured using serum T3, T4 and TSH. Subjects were classified per the ATA-relevant reference ranges. Demographic and anthropometric data were recorded and analyzed. The original dataset and tables are from the study file. Results: Overall TD prevalence was 29% (n=29). Subclinical hypothyroidism (SCH) was most common (16%), followed by overt hypothyroidism (9%), subclinical hyperthyroidism (3%) and overt hyperthyroidism (1%). TD was more frequent in females (female:male = 55:45 overall; higher TD frequency among females) and in those with higher BMI and poorer glycemic control. Microvascular complications were more frequent in patients with TD. Conclusion: A substantial proportion (29%) of newly detected T2DM patients had TD, with SCH being predominant. Routine thyroid screening at diabetes diagnosis should be considered as part of comprehensive endocrine care.
Copyright (c) 2026 Sankavi Santosh Kumar , Santosh Kumar Kamalakannan https://creativecommons.org/licenses/by-sa/4.0
The Two Faces of IUGR: Deciphering the Spectrum of Symmetrical and Asymmetrical IUGR and Mapping Incidence of Causal Dynamics and their Echo on Tracing the Roots of Growth
Background: Intrauterine growth restriction (IUGR) is a major cause of perinatal morbidity and mortality, particularly in developing countries. It results from a complex interplay of maternal, fetal, placental, and environmental factors. Clinically, IUGR is classified as symmetrical or asymmetrical, each with distinct etiopathological mechanisms and perinatal implications. This study aimed to determine the incidence and causal factors of symmetrical and asymmetrical IUGR and to correlate these with fetal and perinatal outcomes. Methods: This cross-sectional observational study was conducted at the Department of Obstetrics and Gynaecology, C.R. Gardi Hospital, Ujjain, from 2023 to 2025. A total of 335 pregnant women diagnosed with IUGR were evaluated, 208 asymmetrical and 127 symmetrical. Detailed maternal history, clinical assessment, ultrasonography and Doppler studies were performed. Data were analyzed during SPSS version 25.0, with p < 0.05 considered statistically significant. Results: Asymmetrical IUGR was more prevalent (62.1%) than symmetrical (37.9%). The majority of cases occurred in women aged 21–30 years. Symmetrical IUGR was more associated with early-onset maternal conditions such as hypertension (28.3%), anemia (30.7%), and nutritional deficiencies (24.4%), while asymmetrical IUGR correlated more with diabetes mellitus (18.8%). Fetal Doppler and biometric parameters showed no statistically significant differences between groups. Neonatal outcomes were comparable, with survival rates exceeding 95% in both subtypes. Conclusion: Both types of IUGR present distinct etiological patterns but similar perinatal outcomes. Early detection, targeted antenatal surveillance, and individualized management are essential to optimize fetal growth and improve neonatal prognosis.
Copyright (c) 2026 RAZIA SULTANA, AVANI AGARWAL https://creativecommons.org/licenses/by-sa/4.0
Cardiorespiratory Fitness between Physically Active and Inactive Obese Medical Students
Background & objectives: Physical inactivity is a well-known factor for cardiometabolic risk among children and adolescents that can be assessed by Cardiorespiratory Fitness (CRF). However, there is a paucity of research on CRF in obese medical students who face academic pressures and lifestyle challenges. The present study aimed to compare CRF between physically active and inactive obese medical students using the Six-Minute Walk test (6MWT). Methods: A cross-sectional comparative study, which enrolled 72 obese medical students (BMI ≥ 25 kg/m2) categorised into physically active (46) and inactive (26) groups based on Metabolic Equivalent of Task (MET) score assessed by Global Physical Activity Questionnaire. All participants underwent 6MWT according to the standardized guidelines of the American Thoracic Society. Blood pressure and heart rate were measured at baseline and after 6MWT, and VO2max was calculated. Data were analysed using an independent t-test and linear regression, with p < 0.05 statistically significant. Results: Weekly physical activity levels measured by MET were markedly higher in the physically active obese group (p = 0.0001), with non-significantly higher estimated VO2max compared to inactive obese following 6MWT. Blood Pressure and heart rate showed a non-significant difference. Linear regression analysis showed a significant positive relationship between 6MWD and VO2max, in active obese students, 6MWD accounts for about 11% variability in VO₂ max (r = 0.3323, p = 0.024) and in inactive obese, nearly 52% (r = 0.7183, p = 0.001). Interpretation & Conclusions: The cardiorespiratory fitness of obese adolescent was similar irrespective of their physical activity status, suggesting obesity may override the effect of physical activity in young age.
Copyright (c) 2026 Sakshi Agrawal, Dr Manisha Sankhla, Dr Anuradha Yadav, Poonam Punjabi Poonam Punjabi, Dr Shikha Mathur https://creativecommons.org/licenses/by-sa/4.0
Annual Demographic Behaviour of Rural Population Covered Under Demographic Surveillance at Palwa Sector, Ujjain District (2023)
Background: Demographic surveillance provides essential insights into fertility, mortality, migration, and maternal and child health indicators, particularly in rural populations where localized data are often limited. National demographic estimates may mask important micro-level variations, highlighting the need for block-level surveillance to support decentralized planning and targeted public health interventions. Aim and Objectives: To analyse and compare demographic characteristics and birth-related events across three rural blocks, Tarana, Mahidpur, and Ghatiya of Ujjain district, using routine demographic surveillance data for the year 2023. The objectives included comparison of live births, childbirth characteristics, mortality patterns, and migration trends, along with evaluation of block-wise demographic indicators. Methodology: This retrospective cross-sectional record-based study was conducted using demographic surveillance data from 60 adopted rural villages under the field practice area of the Tertiary Medical College of Madhya Pradesh. Universal sampling was applied, and all recorded live births, deaths, immigration, and emigration events between 1 January and 30 December 2023 were included. Data were extracted using a structured format, analysed using SPSS software, and summarized using descriptive and inferential statistics, including chi-square tests for block-wise comparisons. Results: The study covered a population of 99,067 and recorded 1,439 live births and 405 deaths, resulting in a crude birth rate of 14.5 per 1000 and a crude death rate of 4.09 per 1000. Ghatiya showed the lowest mortality, highest natural increase, and highest net migration rate, indicating stronger population growth dynamics. Institutional deliveries were predominant across all blocks, and normal vaginal delivery was the most common mode. Female migration constituted the majority of migration events. However, sex ratios at birth were low across all blocks, indicating gender imbalance. Conclusion: The study highlights significant inter-block demographic variations and demonstrates the utility of routine demographic surveillance in identifying localized population trends. Regular surveillance can support evidence-based planning, strengthen maternal and child health programs, and enable targeted public health interventions at block and district levels.
Copyright (c) 2026 Dr Ruchika Sharma, Dr Shrikrishna Singh, Dr BN Mishra, Dr Sudha Goud, Dr Hari Singh Jatav, Dr D N Paliwal https://creativecommons.org/licenses/by-sa/4.0
Sociodemographic Determinants of Hypertension–Obesity–Diabetes (HOD) Complex among Adults in Central India
Background: Hypertension, obesity, and diabetes mellitus are major non-communicable diseases that frequently coexist and substantially increase the risk of cardiovascular morbidity and mortality. The clustering of these conditions, referred to as the hypertension–obesity–diabetes (HOD) complex, reflects shared risk factors and underlying sociodemographic determinants. Understanding these determinants is essential for designing targeted and integrated public health interventions in rapidly transitioning populations such as those in Central India. Aim and Objectives: To determine the association between sociodemographic factors and the HOD complex among adults in Central India. The study also aimed to estimate the prevalence of hypertension, obesity, diabetes, and their clustering, and to identify independent sociodemographic predictors of the HOD complex. Methodology: A community-based cross-sectional study was conducted among 600 adults aged ≥18 years attending health camps under the Family Adoption Program in rural and urban field practice areas of R.D. Gardi Medical College, Ujjain. Data were collected using a pre-tested semi-structured questionnaire. Blood pressure, anthropometric measurements, and random capillary blood glucose were assessed using standardized procedures. Associations were evaluated using chi-square tests, and multivariable logistic regression was performed to determine independent predictors. Results: Among the participants, 33.3% were overweight/obese, 23.7% were hypertensive, 8.5% were diabetic, and 45.0% had prehypertension. Overall, 5.3% had the HOD complex. Obesity was significantly associated with age (p = 0.0001) and gender (p <0.001). Diabetes was significantly associated with age (p = 0.031) and type of family (p = 0.003), while hypertension showed significant associations with age (p = 0.001), gender (p = 0.034), and family type (p = 0.016). On multivariable analysis, increasing age (AOR =2.05; 95% CI: 1.13–3.71), female gender (AOR=6.95; 95% CI: 2.10–23.03), and nuclear family type (AOR=6.38; 95% CI: 2.16–18.88) emerged as independent determinants of the HOD complex, whereas socioeconomic status was not significant. Conclusion: A considerable burden of cardiometabolic conditions and their clustering was observed. Increasing age, female gender, and nuclear family structure were independent determinants of the HOD complex. These findings emphasize the need for integrated community-based screening and targeted preventive strategies focusing on high-risk sociodemographic groups to reduce the growing burden of cardiometabolic diseases.
Copyright (c) 2026 Ruchika Sharma, 1. Dr Sudha Gound, Dr BN Mishra, Dr Saket Kale, Dr Shrikrishna Singh, Dr Hari Singh Jatav, Dr Sapna Rathore https://creativecommons.org/licenses/by-sa/4.0
Effectiveness of Group Versus Individual Physiotherapy on Psychological Well-Being among Sedentary Older Women: A Comparative Study
Background: Aging is associated with reduced physical activity, social isolation, and a decline in psychological well-being. Structured physiotherapy interventions such as group and individual therapy may enhance general well-being in elderly populations. Objective: To evaluate and compare the effects of group and individual physiotherapy interventions on general well-being in community-dwelling elderly women. Methods: In this randomized comparative study, 30 sedentary women aged 60 to 75 years were allocated to group therapy or individual therapy (n=15 each). Both cohorts underwent an identical multimodal 30-minute exercise protocol three times weekly for four weeks. The primary outcome measure was the 18-item General Well-Being Schedule (GWBS). Pre- and post-intervention differences were analyzed using paired and independent t-tests (α = 0.05). Results: Significant within-group improvements were observed in both cohorts. However, between-group analysis demonstrated no statistically significant difference (p > 0.05), but the post mean value difference is greater in group therapy as compared to individual therapy, indicating comparable effectiveness. Conclusion: Structured physiotherapy interventions improve psychological well-being in elderly women irrespective of delivery format. These findings support scalable community-based rehabilitation strategies for healthy aging.
Copyright (c) 2026 Dr. Ruchi Mishra, Dr.Reshhma Khurana, Dr. Sanket Bajpai, Dr. Neha Patidar, Dirgha Sharma https://creativecommons.org/licenses/by-sa/4.0
Cord Blood Hemato-Metabolic Indices and Placental Histopathology as Predictors of Early Neonatal Morbidity: An Integrative Diagnostic Model
Background: Neonatal morbidity reflects a multifactorial interplay between fetal physiology, placental pathology, and the intrauterine inflammatory milieu. While neutrophil-based indices have been extensively studied, alternative hematological and metabolic cord-blood markers such as red cell distribution width (RDW), mean platelet volume (MPV), plateletcrit (PCT), lactate, ferritin, and uric acid may offer additional, clinically feasible insights. When combined with placental histopathology, these parameters may improve the prediction of adverse neonatal outcomes. Objectives: To evaluate the association between cord blood hemato-metabolic indices (RDW, MPV, PCT, lactate, ferritin, uric acid), placental histopathological lesions, and early neonatal morbidity, and to develop an integrated predictive model. Methods: In this prospective observational study, 150 mother–infant dyads were enrolled at a tertiary care centre. Cord blood samples were analyzed for RDW, MPV, PCT, lactate, ferritin, and uric acid using standard laboratory methods. Placentas were examined according to Amsterdam Placental Workshop Group criteria, categorizing lesions into maternal vascular malperfusion (MVM), fetal vascular malperfusion (FVM), and inflammatory lesions, including chorioamnionitis and funisitis. Neonatal outcomes assessed included respiratory distress, early-onset sepsis, NICU admission, low Apgar scores, and need for resuscitation. Associations were evaluated using chi-square tests, t-tests, and multivariable logistic regression. Results: Significant elevations in cord blood RDW, lactate, and ferritin were observed in neonates with placental inflammatory lesions (p < 0.05). MPV and PCT values were markedly altered in cases with FVM and MVM. Elevated lactate (>5 mmol/L) independently predicted need for resuscitation (adjusted OR 3.2), while high ferritin levels were strongly associated with early-onset sepsis (OR 2.9). Uric acid levels showed a significant relationship with low Apgar scores and NICU admission (p < 0.01). The integrated model combining cord blood parameters with placental histopathology demonstrated superior predictive accuracy for neonatal morbidity (AUC 0.85), compared with either biomarker panel or placental lesions alone. Conclusion: Cord blood hemato-metabolic indices—RDW, MPV, PCT, lactate, ferritin, and uric acid—are valuable predictors of neonatal morbidity, particularly when interpreted alongside placental histopathology. These markers are simple, inexpensive, widely available, and suitable for routine laboratory use. The combined cord blood–placenta model offers a robust and clinically practical approach for early risk stratification in neonatal care.
Copyright (c) 2026 Dr Yogesh Singh, Suman Jain, Bharat Marmath https://creativecommons.org/licenses/by-sa/4.0
Push and Pull Factors Guiding Indian Migration to Western Nations: A Cross-Sectional Investigation
Introduction: Global migration has risen markedly, reaching about 304 million people in 2024, with India as the leading country of origin. Increasing numbers of Indian youth migrate to Western countries such as the United States, Canada, the United Kingdom, and Germany, driven by economic constraints, limited domestic opportunities, and aspirations for better education, employment, and quality of life. However, focused evidence on their migration determinants and post-migration challenges remains limited. Therefore, this study aimed to assess the major push and pull factors influencing migration from India to Western countries and to evaluate the challenges experienced by migrants in host nations. Methodology: A cross-sectional study was conducted among 200 Kerala migrants aged 15 to 40 years residing in Western countries between May 2024 and May 2025. Participants were recruited through convenience sampling. Data were collected using a semi-structured questionnaire assessing socio-demographic details, push and pull factors, and post-migration challenges, with determinants categorized using Yi classification. Data were analyzed using SPSS version 26, and ethical approval and informed consent were obtained. Results: Among 200 participants, 49% were aged 18–25 years with equal gender distribution (50% each); 63% held professional degrees, and 62% were unskilled workers. The United Kingdom (23%) and Canada (19%) were the most preferred destinations. Low wages (45%) and unemployment (41%) were major economic push factors, while quality of life (47%) and improved living standards (39%) were key pull determinants; corruption (36%) also contributed. Based on Yi’s classification, 53.5% migrated mainly due to push factors. Common post-migration challenges included language barriers (53%), workplace adjustment issues (43%), discrimination (31%), high cost of living (35%), and lack of government support (64%). Conclusion: Migration in this cohort was predominantly driven by push factors such as economic insecurity, unemployment, and governance-related concerns, while pull factors, including better living conditions and quality of life, reinforced decisions. Economic disparities, social aspirations, and political instability collectively shaped migration motives. Post-migration challenges, including language barriers, workplace adjustment difficulties, discrimination, and high living costs, highlighted the need for economic reforms at origin and stronger integration support in destination countries.
Copyright (c) 2026 Narayanan Namboothiri G, Asna P, Aswani S, Avanthika A, Aysha Azeem, Aysha Moonam Kandathil, Aysha Nabeela V P, Azeem Ali V P https://creativecommons.org/licenses/by-sa/4.0
Assessment of Oxidative Stress-Induced Anemia and Nutritional Deficiency in Various Arthritic Conditions: A Clinical Study
Background: Arthritis encompasses a spectrum of chronic inflammatory disorders affecting joints and connective tissues, including conditions like rheumatoid arthritis (RA), osteoarthritis (OA), and Ankylosing spondylitis (AS). These disorders are frequently accompanied by systemic complications such as anemia and nutritional deficiencies. A growing body of evidence suggests that oxidative stress—an imbalance between reactive oxygen species (ROS) and antioxidant defenses—plays a pivotal role in the pathogenesis of arthritis and contributes to anemia by damaging erythrocytes and impairing erythropoiesis. Moreover, chronic inflammation in arthritis affects the absorption, metabolism, and utilization of essential micronutrients, leading to nutritional deficiency. Objectives: The aim of this study was to assess the prevalence and severity of oxidative stress-induced anemia and nutritional deficiencies in patients with different arthritic conditions. Materials and Methods: This hospital-based, observational clinical study included 120 diagnosed arthritis patients (40 each from RA, OA, and AS groups) attending the outpatient department of a tertiary care center. Patients were evaluated for hemoglobin (Hb), red cell indices, serum iron, ferritin, vitamin B12, folate, and oxidative stress biomarkers, including malondialdehyde (MDA), superoxide dismutase (SOD), and total antioxidant capacity (TAC). Standard biochemical methods and automated analyzers were used. Statistical analysis was performed using Microsoft Excel software, with p <0.05 considered statistically significant. Results: Anemia was found in 76.6% of patients, with the highest prevalence in RA (85%), followed by AS (75%) and OA (70%). Mean MDA levels were significantly elevated in RA and AS compared to OA, indicating higher oxidative stress. Antioxidant enzymes like SOD and TAC were markedly decreased in all arthritis subgroups. Nutritional deficiencies, especially of iron and vitamin B12, were more common in RA patients. A significant inverse correlation was observed between MDA levels and hemoglobin concentration (r = -0.48, p < 0.01). Positive correlations were noted between antioxidant status and nutritional markers. Conclusion: Oxidative stress-induced anemia and nutritional deficiencies are prevalent in various arthritic disorders, especially in RA and AS. Early screening for oxidative and nutritional markers in arthritic patients can improve clinical outcomes by guiding antioxidant and nutritional support strategies.
Copyright (c) 2026 Arvind Gupta https://creativecommons.org/licenses/by-sa/4.0
Nursing Interventions and Their Impact on Cardiovascular Risk Factors in Patients with Aortic Valve Vegetation and Antiphospholipid Antibody Syndrome
Nursing interventions play a crucial role in managing cardiovascular risks in patients with aortic valve vegetation (AVV) and antiphospholipid antibody syndrome (APS). Nurses are key in anticoagulation therapy, infection prevention, cardiovascular risk management, and patient education. They also offer supportive counselling and promote lifestyle modification, including changes such as eating healthier and engaging in more frequent exercise, to improve patient outcomes. By enhancing self-care, medication adherence, and anxiety reduction, nursing interventions improve quality of life and reduce complication rates. These findings stress the critical contribution of nursing to the optimization of care, recovery enhancement, and minimization of cardiovascular risks among patients with AVV and APS.
Copyright (c) 2026 kalpana Singh, Aliyah Sange https://creativecommons.org/licenses/by-sa/4.0
Exploring Innovations in Secondary Metabolites and Their Effects on Pain, Inflammation and Metabolic Syndrome
Secondary metabolites, once considered non-essential by-products of plant and microbial metabolism, have emerged as potent bioactive molecules with tremendous therapeutic promise. Recent advances in biotechnology, omics technologies, and natural product chemistry have enabled the identification and engineering of these molecules at an accelerated pace, highlighting their potential to modulate complex disease mechanisms. This editorial discusses novel breakthroughs in secondary metabolites, focusing on their applications in pain modulation, anti-inflammation, and metabolic regulation. Through exemplary examples, we emphasize the translational potential of these natural products and underline the necessity of an interdisciplinary strategy to surmount current bottlenecks in clinical translation.
Copyright (c) 2026 kalpana Singh, Treeza https://creativecommons.org/licenses/by-sa/4.0
Altered Riding Posture and Postural Pain in a Motorbike Rider: A Case Report
Background: Motorcycle riding for prolonged durations, particularly on sport bikes, often requires a flexed trunk posture with thoracic kyphosis and scapular protraction. Sustained faulty riding posture combined with inadequate ergonomic awareness may lead to musculoskeletal disorders involving the neck, shoulder, and upper back. Such biomechanical stress can result in postural abnormalities, pain, and functional limitations affecting activities of daily living. Physiotherapy plays an important role in the conservative management of these conditions through pain reduction, postural correction, and functional rehabilitation. Case Description: This case report describes a 26-year-old male student who presented with severe right shoulder and upper back pain following an 800-km continuous ride on a sports motorbike performed without adequate preparation or rest intervals. The patient reported progressive pain, morning stiffness, and difficulty performing daily activities. Clinical examination revealed protracted shoulders, increased thoracic kyphosis, trigger points in the thoracic paraspinals and trapezius muscles, and significant tenderness from T1–T6 levels. Baseline pain intensity on the Visual Analog Scale (VAS) was 8/10, with restricted cervical and shoulder range of motion and reduced muscle strength. Radiological investigations, including X-ray and MRI, ruled out structural abnormalities. Intervention: A structured physiotherapy rehabilitation program was implemented for six weeks. The treatment protocol included heat therapy, myofascial release using instrument-assisted soft tissue mobilization (IASTM), transcutaneous electrical nerve stimulation (TENS), stretching exercises, Swiss-ball–based postural correction, strengthening exercises with Thera-bands, spinal extension exercises, neck isometrics, and functional rehabilitation. The program aimed to reduce pain, restore mobility, correct posture, and improve muscular strength and biomechanical alignment. Results: Following six weeks of physiotherapy intervention, the patient demonstrated significant improvement in clinical outcomes. Pain intensity reduced from 8/10 to 2/10 on the VAS scale. Shoulder and cervical range of motion improved considerably, and muscle strength increased as measured using a handheld dynamometer. Postural correction was also observed with a reduction in thoracic kyphotic posture and scapular protraction. Conclusion: Prolonged motorcycle riding with improper posture and inadequate rest can lead to biomechanical stress and musculoskeletal pain in the cervical and thoracic regions. This case highlights the effectiveness of a comprehensive physiotherapy rehabilitation program in managing postural pain associated with motorcycle riding. Awareness of proper riding ergonomics and physical conditioning before long rides may help prevent such conditions
Copyright (c) 2026 Dr Grishma Agarwal Grishma https://creativecommons.org/licenses/by-sa/4.0
A Case of Neuroleptic Malignant Syndrome Following Antipsychotic Overdosage: A Case of Survival
Background: Neuroleptic Malignant Syndrome (NMS) is a rare but potentially fatal adverse reaction to dopamine receptor–blocking agents. It is characterized by hyperthermia, generalized rigidity, altered sensorium, autonomic instability, and elevated serum creatine kinase (CK). Antipsychotic overdosage is a recognized precipitating factor, and early diagnosis is critical for survival. Methods: This is a descriptive single-patient case report. Clinical evaluation, laboratory investigations including serum CK and liver enzymes, and neuroimaging were used to establish the diagnosis. Management involved immediate discontinuation of antipsychotics, intensive care monitoring, aggressive supportive treatment, and dopaminergic agents. Case Discussion: A 45-year-old male with schizophrenia presented with five days of high-grade fever, severe generalized “lead-pipe” rigidity, altered consciousness, and poor oral intake following excessive ingestion of risperidone and olanzapine. Examination revealed hyperthermia, tachycardia, and labile blood pressure. Investigations showed leukocytosis, markedly elevated CK, and raised liver enzymes; MRI brain was normal. The patient was managed in the ICU with active cooling, intravenous hydration, electrolyte correction, bromocriptine, and amantadine. Gradual clinical and biochemical improvement occurred over one month. Subsequent cautious antipsychotic rechallenge with low-dose clozapine and amisulpride was well tolerated. Conclusion: Early recognition, prompt withdrawal of offending agents, intensive supportive care, and multidisciplinary management are essential for survival in NMS. Carefully monitored antipsychotic rechallenge can be safely undertaken after complete recovery.
Copyright (c) 2026 Dr Siddharth Rathore, Dr. Chandrakant Salve, Priya Rai, Udit Agrawal, Snehil Mavi https://creativecommons.org/licenses/by-sa/4.0
The Forgotten Valve: Pulmonary Valve Endocarditis in Late Pregnancy
Infective endocarditis is a microbial infection of the cardiac endocardium, most often involving native or prosthetic valves. It commonly presents with persistent fever, malaise, anemia, and a new or changing murmur, along with possible cutaneous signs or systemic embolic features. The condition may progress to serious complications such as valvular regurgitation, heart failure, conduction abnormalities, stroke, and renal impairment. In this case report, we present a 21-year-old antenatal woman with an atrial septal defect who presented with fever and cough and was initially treated for community-acquired pneumonia. Following an emergency caesarean section, the mother developed persistent fever despite the administration of antibiotics. Careful clinical examination prompted the evaluation of the heart, identifying a pulmonary valve pathology. Further investigations by obtaining blood cultures grew methicillin-resistant Staphylococcus aureus, which was then treated appropriately. The outcome was a successful recovery of the patient’s usual state of health.
Copyright (c) 2026 Sahasyaa Adalarasan https://creativecommons.org/licenses/by-sa/4.0
Background: Pancoast tumors are uncommon malignancies located in the superior sulcus of the lung, characterized by distinctive neurological and vascular involvement. However, extensive venous thrombosis and contralateral nodal involvement are rarely described. Case Presentation: We report a striking case in a 64-year-old male smoker who presented with chest pain, facial swelling, dyspnea, and right-sided Horner’s syndrome. Imaging revealed a right apical mass invading the thoracic inlet with bilateral internal jugular vein thrombosis and contralateral supraclavicular lymphadenopathy. Histology showed acinar adenocarcinoma. Management and Outcome: Given extensive locoregional and systemic involvement, curative resection was not feasible, and palliative systemic therapy was initiated. Conclusion: This rare constellation of findings underscores the aggressive biological behavior of superior sulcus tumors and emphasizes the need for heightened clinical suspicion and early multidisciplinary evaluation.
Copyright (c) 2026 Dr. Mustafa Singapurwala Mustafa, Nandinee , Bharat Kumawat, Mahak Mundra, Arti julka, Dr. J.C. Agrawat https://creativecommons.org/licenses/by-sa/4.0
A Diagnostic Trap: Fatal Leptospirosis in Disguise
Leptospirosis is a common post-monsoon zoonosis and an important cause of febrile jaundice with acute kidney injury (AKI). We report a 35-year-old farmer with floodwater exposure who presented with fever, myalgias, jaundice, oliguria, shock and breathlessness. Investigations showed severe hyperbilirubinaemia (peak 44 mg/dl), AKI, thrombocytopenia, metabolic acidosis and bilateral pulmonary infiltrates. Despite antibiotics and intensive supportive care, he progressed to refractory multiorgan dysfunction syndrome (MODS) and succumbed following attempted albumin dialysis. This case highlights leptospirosis as a diagnostic trap and reinforces the need for early suspicion and timely organ-support in severe disease.
Copyright (c) 2026 Dr SAI VISHNU BATTU https://creativecommons.org/licenses/by-sa/4.0
An Interesting Case of Term Pregnancy with Asymptomatic Transverse Vaginal Septum
A transverse vaginal septum is a rare congenital anomaly of the reproductive tract that can be a result of faulty canalization, fusion, and resorption of Müllerian ducts. It could be a complete obstructive septum found at the time of menarche, similar to an imperforate hymen. It can also present as a transvaginal septum having an eccentric tiny hole, giving an impression of a vaginal vault without a cervix. A 27-year-old primigravida presented at 39 weeks and 5 days of gestation in labor. On per speculum examination, a mid-vaginal septum with an eccentric pinpoint opening was seen. The patient was taken for an emergency lower-segment cesarean section. Postoperatively, the mother and baby were both healthy.
Copyright (c) 2025 Shalini Srivastava, Pulak Kumar Roy, Deepika Jain https://creativecommons.org/licenses/by-sa/4.0
Chronic Inversion of Uterus with Submucous Fibroid Polyp Presenting in a Postmenopausal Woman
Background: Chronic uterine inversion is an exceptionally rare gynecological condition, often misdiagnosed due to its nonspecific presentation. Unlike the acute puerperal form, chronic non-puerperal inversion typically results from underlying uterine pathology and poses unique diagnostic and surgical challenges. Case Presentation: We report the case of a 64-year-old postmenopausal woman presenting with chronic pelvic discomfort, vaginal bulging, and abnormal bleeding. Physical examination revealed a large vaginal mass with associated polypoid tissue. Ultrasound imaging confirmed uterine inversion, characterized by the typical “bowl-shaped” uterine contour. Surgical management was undertaken via an abdominal approach. Intraoperative findings revealed complete uterine inversion with fundal involvement of both round ligaments and adnexa. A Haultain-like approach was employed to restore anatomy, followed by hysterectomy due to the patient’s age and uterine pathology. Histopathology revealed a submucosal fundal fibroid polyp with chronic endometritis. The patient had an uneventful recovery and remained symptom-free at six weeks postoperatively. Conclusion: This case underscores the importance of considering chronic uterine inversion in the differential diagnosis of pelvic organ prolapse, particularly in postmenopausal women with a history of unmonitored vaginal deliveries. Prompt diagnosis via imaging and tailored surgical intervention are critical for optimal outcomes. Hysterectomy remains a definitive treatment in postmenopausal cases with underlying uterine pathology.
Copyright (c) 2026 Ranu Mirdha, P K Roy https://creativecommons.org/licenses/by-sa/4.0
Fluoroquinolone-Induced Fixed Drug Eruption: A Clinically Significant Case Report
Fixed drug eruption (FDE) is a well-recognized cutaneous adverse drug reaction (ADR) characterized by the recurrence of lesions at the same anatomical site upon re-exposure to the offending drug. Although most cases are benign, severe or generalized variants can significantly impair quality of life. We present the case of an 18-year-old male who developed multiple hyperpigmented patches and blistering after administration of ofloxacin, a commonly prescribed fluoroquinolone antibiotic. Lesions recurred after inadvertent re-challenge, confirming the diagnosis of drug-induced FDE. Causality assessment using both the WHO-UMC system and the Naranjo algorithm classified the event as “probable.” The patient responded well to systemic corticosteroids, topical corticosteroids, and non-sedating antihistamines, with complete resolution over three weeks. This case emphasizes the importance of careful drug history, patient counselling, and the role of pharmacovigilance in preventing recurrent ADRs.
Copyright (c) 2026 Avani Shakalya https://creativecommons.org/licenses/by-sa/4.0
Dental Fluorosis: A Community-Clustered Case Series
Background: Dental fluorosis, a condition resulting from excessive fluoride intake during tooth development, is a preventable public health problem. This case series examines this in a rural community in the Ujjain district in Madhya Pradesh, India, identified through a postgraduate community adoption program. Methods: Cases of dental fluorosis were detected from Lambikhedi village in the Mahidpur block, Ujjain District, through routine school health survey and subsequently confirmed at the dental department. The severity of fluorosis was assessed using the ICMR and Dean’s Indices. All drinkable water sources of the concerned village were checked for fluoride content. The study was conducted between December 2023 and March 2024. Results: This study detected five children aged 5 to 11 years, with varying degrees of dental fluorosis: two cases classified as grade III, two as grade II, and one as grade I according to the ICMR index. Analysis of all three drinking water sources revealed fluoride levels between 1.51 mg/L and 1.65 mg/L, which exceed acceptable limits (1.0 mg/L) and permissible limits (1.5 mg/L). This case series includes clinical findings, fluorosis grades, water quality reports, and individualized treatment plans. Conclusion: This study highlights the endemic nature of dental fluorosis and high fluoride levels in rural India’s drinking water. Effective screening, water defluoridation, and community-based oral health education are essential. A community adoption program for postgraduate students at medical colleges can greatly enhance these efforts.
Copyright (c) 2026 Dr Jagrati Bahrani, Dr Bidushi Mishra, Dr Nidhi D Sinha, Dr Badrinarayan Mishra, Dr Sapna Rathore, Dr Nitin Bhargava https://creativecommons.org/licenses/by-sa/4.0
Data Collection Tools and Methods under Clinical Studies
To generate quality evidence regarding informed decisions for clinical/ public health practice, quality data collection is an integral part of every clinical study, regardless of the involved research questions, hypotheses and objectives. As such, data collection is the systematic, purposeful process of information gathering, measuring, and analyzing accurate, targeted information from various sources to answer research questions, test hypothesized hypotheses, and support decision-making. The process of data collection might broadly consist of two components: tools of data collection (e.g., questionnaires) and methods of data collection (e.g., surveys, interviews, observations, focus group discussions, and others). The present write-up briefly describes them and their related aspects to make the readers aware of them while planning any clinical study.
Copyright (c) 2026 Sada Nand Dwivedi https://creativecommons.org/licenses/by-sa/4.0
Anger Management Through Chanting Kalabhairava Ashtakam: A Physiological Perspective
Anger is defined as an emotional state that varies from mild irritation to rage. The cause for anger can be subjective. Anger plays a key role in the diagnosis of psychological disorders, and it affects the personality of an individual. Anger is effectively managed by various medications like mood stabilisers, anxiolytics, anti-depressants etc., which also have considerable side effects. Medications supported with lifestyle changes, relaxation and stress management techniques have proven to be more effective in managing anger.The Kala Bhairava Ashtakam is a Sanskrit hymn composed by the visionary philosopher Sri Adi Shankaracharya of the 8th century. The mantras in this are dedicated to Kala Bhairava, an intense form of Lord ShivaAn individual who chants the Kalabhairava Ashtakam, which is beautiful and a source of knowledge, will be free from all negative emotions, including anger. Hence, Chanting of Kalabhairava Ashtakam can be incorporated in everyday lifestyle for the well-being of an individual. As there are no scientific studies in this area, it is highly recommended to undertake a research study to provide scientific evidence for the effectiveness of the chanting Kalabhairava Ashtakam in the management of Anger.
Copyright (c) 2026 Dr. Sai Sailesh kumar Goothy, Bhagya Shree, Satish S Patil, Syed Sadat Ali, Jinu K V, krishna Mohanty, Aanandi Sirivoru https://creativecommons.org/licenses/by-sa/4.0