Background Gestational diabetes mellitus (GDM) constitutes a significant public health challenge in India, particularly impacting pregnant women and posing risks to both maternal and fetal health. Despite the growing prevalence of GDM, limited qualitative evidence is available regarding the health-seeking behaviors of women in Odisha. This study aimed to explore the health-seeking behaviors among women diagnosed with GDM. Methods A descriptive exploratory research design was used at a tertiary care hospital in Odisha, India. Women diagnosed with GDM were recruited through purposive sampling, excluding those with pre-existing chronic conditions. One-on-one interviews were conducted with 21 participants in the Odia language, audio-recorded, transcribed verbatim, and analyzed using thematic analysis supported by NVivo software, version 14 (trial version; Lumivero, Denver, CO, USA). Trustworthiness was ensured through member checking, prolonged engagement, and detailed contextual descriptions. Results Thematic analysis was performed for the transcripts, and six key themes emerged from the analysis: emotional responses to diagnosis, including fear, guilt, and denial; inconsistent information delivery from healthcare providers; expectations for empathetic care, continuity of care, and peer support; positive changes in health behaviors, such as improved dietary practices, increased physical activity, and heightened health awareness; barriers to healthcare access, which included transportation challenges, financial constraints, and cultural or linguistic obstacles; and determinants of health-seeking behavior shaped by family support, cultural beliefs, competing responsibilities, and perceptions of medical interventions. Family encouragement was found to facilitate adherence, while misconceptions and logistical barriers hindered effective management. Conclusion This study identified key themes surrounding health-seeking behaviors, specifically emotional responses to diagnosis, the perceived adequacy of information, expectations of healthcare providers, positive lifestyle modifications, barriers to accessing care, and the overarching determinants of health-seeking behavior. To optimize patient outcomes, these dimensions must be actively addressed by healthcare personnel and systematically integrated into healthcare services.
Workplace violence against doctors has become an increasingly important concern in hospital settings, particularly in emergency departments and high-volume tertiary hospitals where clinical urgency, emotional distress, overcrowding, and resource limitations commonly intersect. Patients' relatives and companions represent a particularly important group in this context because they often function as caregivers, advocates, financial decision-makers, and intermediaries between the patient and the healthcare system. Their aggressive reactions may be triggered by fear, uncertainty, poor prognosis, perceived delays, unmet expectations, or inadequate communication. This narrative review synthesizes current evidence on violence against doctors by patients and their relatives in hospital settings, with emphasis on risk factors, communication failures, psychological and system-level drivers, consequences, and prevention strategies. A structured Scale for the Assessment of Narrative Review Articles (SANRA)-guided narrative methodology was used to review relevant literature from PubMed/MEDLINE, ScienceDirect, SpringerLink, BMJ Open, PubMed Central, Google Scholar, and institutional sources such as the World Health Organization. Included sources addressed workplace violence, patient or relative aggression, emergency department violence, doctor-patient communication, burnout, and mitigation strategies. The evidence indicates that aggression toward doctors is usually multifactorial and can be understood through both organizational behavior and patient-provider conflict perspectives. From an organizational perspective, violence may arise when overcrowding, staff shortages, long waiting times, limited resources, weak security systems, and inadequate reporting mechanisms create a high-pressure clinical environment. From an interpersonal conflict perspective, aggression may develop when relatives' expectations, emotional distress, and need for information are not aligned with clinical realities, triage priorities, or available hospital resources. Communication failure appears to be one of the most modifiable drivers of aggression, particularly when relatives receive inconsistent or insufficient information about diagnosis, prognosis, delays, or clinical priorities. The consequences of violence extend beyond immediate harm and include anxiety, burnout, reduced morale, defensive medical practice, disruption of team functioning, underreporting, and compromised patient safety. Overall, violence against doctors by patients and their relatives should be approached as both an occupational safety issue and a healthcare quality problem. Effective prevention requires integrated hospital-level strategies, including communication training, structured family updates, visible triage explanations, waiting-time communication, environmental safety measures, incident reporting systems, leadership accountability, and post-incident support. Future research should examine patients' relatives as a distinct group, particularly in emergency departments, tertiary hospitals, and resource-limited healthcare settings.
Background Refractive error is a widespread cause of decreased visual acuity, which can impact academic success, work productivity, and quality of life. Uncorrected visual acuity (UCVA) provides baseline information regarding refractive status before optical correction. The purpose of this study was to compare UCVA between adults aged 18-25 years and 38-45 years. Methodology This cross-sectional study was conducted in the Department of Optometry at the NSHM College of Management and Technology, Durgapur, West Bengal, India, between November 2025 and April 2026. A total of 300 participants undergoing refractive assessment were enrolled, comprising two equal age groups. Group A consisted of 150 individuals aged 18-25 years, and Group B consisted of 150 individuals aged 38-45 years. UCVA was measured using a Snellen chart and subsequently converted to logMAR values for statistical analysis. Each participant underwent a comprehensive refraction assessment and was included in the study only if their best-corrected visual acuity was 6/9 or better. Welch's independent-samples t-test was applied to compare UCVA between the groups, while categorical variables were analyzed using the chi-square test. Results The mean UCVA for the right eye was significantly poorer in the 18-25-year group than in the 38-45-year group (0.249 ± 0.199 vs. 0.142 ± 0.117 logMAR; mean difference: 0.107; 95% confidence interval (CI): 0.070-0.144; p < 0.001). Left eye UCVA was poorer in the younger group (0.187 ± 0.199 vs. 0.136 ± 0.120 logMAR; mean difference: 0.051; 95% CI: 0.014-0.088; p = 0.008). There was no significant difference in gender distribution between the groups (p = 0.160). The distribution of refractive errors varied significantly between the groups (p < 0.001), and compound myopic astigmatism was more prevalent in the 18-25-year group (149 eyes, 49.7%) compared with the 38-45-year group (1 eye, 0.3%). Conclusions The UCVA scores of participants aged 18-25 years were significantly lower than those of the 38-45-year-old participants. The poorer UCVA was mainly associated with higher compound myopic astigmatism, highlighting the need for regular refractive screening and timely optical correction among young adults.
Bundibugyo virus disease (BVD) is a high-consequence filovirus infection with no approved vaccine or specific therapeutic, making early detection, supportive care, infection prevention, and coordinated public health action essential. This editorial is a rapid narrative synthesis of publicly available outbreak information from the WHO Disease Outbreak News, the Centers for Disease Control and Prevention (CDC) reports, the Uganda Ministry of Health updates, and the WHO African Region situation materials. We prioritized official reports because the event was rapidly evolving and because case counts, contact-tracing indicators, and health-zone classifications were being updated as surveillance and laboratory capacity expanded. This editorial summarizes the May-July 2026 BVD outbreak involving the Democratic Republic of the Congo (DRC) and Uganda and highlights public health lessons for cross-border preparedness. We reviewed official WHO, CDC, Uganda Ministry of Health, and WHO African Region reports, with data reviewed through July 3, 2026. WHO was alerted on May 5, 2026, to a high-mortality illness cluster in Mongbwalu Health Zone, Ituri Province, DRC. The DRC and Uganda declared outbreaks on May 15, 2026, and the WHO determined that the event constituted a public health emergency of international concern. Response measures included surveillance, laboratory expansion, isolation and supportive care, contact tracing, infection prevention and control, safe burial, community engagement, cross-border coordination, and preparation for ethically approved trials of candidate countermeasures. This outbreak shows that border-linked surveillance must be integrated with first-contact facility readiness, health-worker protection, trusted community engagement, continuity of essential services, complete contact follow-up, and trial-ready systems rather than reliance on generic Ebola plans or indiscriminate travel restrictions.
Aims and objectives Creative writing has already been utilized within the context of care and rehabilitation of patients suffering from various mental and physical conditions, yielding positive outcomes. The aim of this study is to examine whether and how the psychosomatic state of chronic pain patients is affected by their engagement with creative writing. Methodological design The study employed a non-randomized design and used a longitudinal controlled quasi-experimental design with two parallel groups assessed at three timepoints: pre-intervention (T1), mid-intervention (T2), and post-intervention (T3). Ethical issues and approval Participants provided written informed consent, and the study was approved by the Scientific Council of the University General Hospital of Alexandroupolis (approval number: 50535/18-10-2023). Research methods and interventions This controlled longitudinal quasi-experimental study included 120 adults with chronic pain, allocated to an intervention group (n = 60) or a control group (n = 60), and compared the effects of a creative writing intervention against a waitlist control on self-assessed pain severity, quality of life, anxiety, and self-rated health, assessed at three timepoints (T1 = baseline; T2 = mid-point; T3 = post-intervention). Results Over an observation period of two weeks, the control group showed near-zero change on every outcome: pain, anxiety, functional impairment, and health. The intervention group, by contrast, showed a progressive improvement in self-rated health and a meaningful decrease in anxiety, while pain severity and functional impairment remained broadly stable. Conclusions The intervention was associated with significant reductions in anxiety and depression and meaningful improvements in self-rated health by the end of the observation period. Pain severity itself did not change significantly at the group level, but the way pain related to other aspects of quality of life differed markedly between the two groups.
Background Hemorrhoidal disease is one of the most common benign anorectal disorders encountered in surgical practice. Although various surgical modalities are available for grade III and IV hemorrhoids, Milligan-Morgan hemorrhoidectomy remains the gold standard treatment. However, postoperative pain is a major complication associated with this procedure. Therefore, hemorrhoidectomy using the harmonic scalpel (HS) has gained attention because of its potential to reduce tissue injury and postoperative pain. Methods This prospective single-center observational study included 112 patients with grade III and IV hemorrhoids who underwent hemorrhoidectomy using the conventional technique (n = 59) or the harmonic scalpel (n = 53) at a tertiary teaching hospital between December 2024 and May 2026. Approval was obtained from the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research (approval number: CSP-MED/24/OCT/110/327), and written informed consent was obtained from all the participants. The study aimed to compare the efficacy of hemorrhoidectomy using the harmonic scalpel with the conventional technique in terms of perioperative outcomes. The primary outcomes included intraoperative bleeding, operating time, and postoperative pain, whereas secondary outcomes included the duration of hospital stay and postoperative urinary retention. Statistical analysis was performed, and a p-value of <0.05 was considered statistically significant. Results A significant reduction in operating time (<0.001), intraoperative blood loss (<0.001), postoperative pain (<0.001), postoperative urinary catheterization (0.018), and hospital stay (<0.001) was noted in the group undergoing hemorrhoidectomy using the harmonic scalpel compared with the conventional group. Conclusion Patients undergoing hemorrhoidectomy using the harmonic scalpel demonstrated a significant reduction in intra- and postoperative complications compared with the conventional group, suggesting greater efficacy in the management of grade III and IV hemorrhoids.
Hepatic adrenal rest tumours (HARTs) are rare benign lesions arising from ectopic adrenocortical tissue. Their radiological resemblance to hepatocellular carcinoma (HCC) presents a significant diagnostic challenge. We report a case of HART in a woman in her 60s with chronic hepatitis B (CHB) without cirrhosis who underwent surgical resection following a preoperative diagnosis of HCC. The patient, who was of Filipino descent, was being treated with entecavir and underwent a routine six-monthly HCC surveillance, during which a lesion of concern was identified on ultrasound. Liver synthetic function and serum transaminases were within normal limits, hepatitis B viral load was undetectable, and serum alpha-fetoprotein was normal. MRI demonstrated a 14-mm fat-containing lesion in segment VI according to the Couinaud classification, exhibiting homogeneous arterial phase hyperenhancement and portal venous washout, findings considered radiologically consistent with HCC. Following multidisciplinary review, she underwent laparoscopic hepatectomy. Histopathological examination revealed a well-circumscribed lesion composed of compact nests of uniform cells with regular round nuclei and finely vacuolated clear cytoplasm. Immunohistochemistry demonstrated positivity for inhibin and Melan-A, with negative staining for PAX8, HepPar-1, AE1/AE3, S100, HMB45, synaptophysin, and chromogranin, establishing the diagnosis of HART. This case highlights the difficulty in distinguishing HART from HCC based on imaging alone, particularly in patients with established HCC risk factors. Recognition of HART as a potential differential diagnosis for hypervascular hepatic lesions may support more informed multidisciplinary evaluation and management.
Accurate assessment of fertility rates and their long-term trends is essential for understanding reproductive dynamics, anticipating the healthcare and socioeconomic consequences of demographic change, and informing family planning and population policies. The aim of this study was to investigate long-term trends in the general fertility rate (GFR) in Greece using nationwide population data. Official national data on annual live births and the female population aged 15-44 years were obtained from the Hellenic Statistical Authority for the period 1956-2024. The GFR was calculated as the annual number of live births per 1,000 women of reproductive age (WRA). An age-standardized GFR (ASGFR) was also calculated for each study year using the 2013 European Standard Population. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs) and corresponding 95% confidence intervals (95% CIs). The GFR declined during 1956-1980 (APC = -0.3, 95% CI: -0.4 to -0.2), with two historic peaks recorded in 1959 and 1967, when it reached 81.6 and 80.7 births per 1,000 women aged 15-44 years, respectively. Over the subsequent two decades, the GFR declined further (1980-1989: APC = -4.7, 95% CI: -5.5 to -4.2; 1989-1999: APC = -1.2, 95% CI: -1.6 to -0.7). From 1999 to 2009, the GFR increased (APC = 2.1, 95% CI: 1.7 to 2.6). Thereafter, it entered a renewed period of decline, reaching a historic low of 39.4 births per 1,000 women aged 15-44 years in 2024, representing a 25% decrease compared with 2009. This decline was characterized by two periods of significant reduction, during 2009-2013 (APC = -3.7, 95% CI: -5.4 to -2.0) and 2021-2024 (APC = -5.0, 95% CI: -8.1 to -3.0), with a period of relative stability between 2013 and 2021. Following a period of stability during 1956-1963, the ASGFR increased during 1963-1967 (APC = 2.6, 95% CI: 1.3 to 4.1) and subsequently declined during 1967-1999. The rate increased again during 1999-2009 (APC = 2.3, 95% CI: 1.9 to 2.7), declined during 2009-2013 (APC = -3.4, 95% CI: -5.9 to -0.7) and 2021-2024 (APC = -4.4, 95% CI: -6.9 to -1.8), whereas it showed a modest upward trend during 2013-2021 (APC = 0.9, 95% CI: 0.2 to 1.7). During 2009-2024, approximately 70% of the overall decline in the GFR was attributable to declining fertility rates and 30% to changes in the age composition of women of reproductive age. However, the contribution of these factors shifted over time: alterations in the age distribution of women of reproductive age accounted for most of the decline during 2009-2021, whereas fertility decline became the predominant driver during 2021-2024. This nationwide study demonstrates a sustained long-term decrease in the GFR in Greece over nearly seven decades, culminating in a historic low in 2024, despite a temporary recovery between 1999 and 2009. The recent GFR downward trend observed from 2009 to 2024 was the result of fertility decline, exacerbated by unfavorable shifts in the age structure of women of reproductive age.
A diabetic woman in her 40s presented with a subacute onset of a left temporal headache with no other symptoms, especially no visual or nasal symptoms. An initial diagnosis of giant cell arteritis was made due to a raised erythrocyte sedimentation rate (ESR) and the presence of jaw claudication; however, the temporal artery biopsy was negative. Corticosteroid therapy was commenced, but subsequent computed tomography (CT) imaging of the face revealed extensive left maxillary sinus disease with bony erosion of the greater palatine and vidian nerve canals. The ear, nose, and throat (ENT) examination showed no mucosal necrosis, and initial biopsies were negative for mucormycosis. Given the imaging findings, a tentative diagnosis of mucormycosis was made, and the patient was treated with liposomal amphotericin B. Repeat deep biopsies confirmed the diagnosis of mucormycosis. The nature of the headache was consistent with pterygopalatine neuralgia, given the headache characteristics, taste abnormality, and magnetic resonance imaging (MRI) findings at the pterygopalatine fossa. The importance of the pterygopalatine fossa as a conduit for potential mucormycosis perineural spread is highlighted. This case also underscores mucormycosis as an important mimic of giant cell arteritis, particularly in patients presenting with new-onset unilateral headache and cranial neuropathies.
Periodontal pockets persisting after non-surgical periodontal therapy may require surgical intervention to facilitate adequate access for root debridement and elimination of inflamed pocket tissues. Modified Widman flap surgery remains a predictable periodontal surgical procedure that allows thorough debridement while preserving soft tissue architecture. A 45-year-old female patient presented with pain in the gums during mastication in the maxillary right quadrant. Clinical examination revealed residual periodontal pockets measuring 5 mm extending from the maxillary right central incisor to the first molar following completion of Phase I periodontal therapy. Bleeding on probing was present, and the clinical attachment level measured 4 mm. The patient was systemically healthy and had no history of smoking. A diagnosis of Stage II periodontitis was established. Modified Widman flap surgery with osseous recontouring was performed under local anesthesia. Following internal bevel and crevicular incisions, a full-thickness mucoperiosteal flap was reflected. Inflamed pocket epithelium and granulation tissue were removed, root surfaces were thoroughly debrided, and osseous recontouring was performed to establish physiologic architecture. The flap was stabilized using 3-0 polyglycolic acid/polylactic acid (PGA/PLA) sutures. Healing was uneventful throughout the postoperative period. At three months, probing pocket depth was reduced, and gain in clinical attachment level was observed; also, bleeding on probing was absent. Minimal postoperative gingival recession, mobility, or furcation involvement was observed. Modified Widman flap surgery combined with osseous recontouring provided favorable clinical outcomes in the management of residual periodontal pockets, resulting in reduced probing depths, attachment gain, and maintenance of soft tissue architecture after three months.
Background Dolutegravir (DTG)-based combination antiretroviral therapy (cART), specifically the tenofovir disoproxil fumarate, lamivudine, and dolutegravir (TLD) regimen, is being widely prescribed for the management of people living with HIV (PLHIV) in India and other low- and middle-income countries. Although DTG is well-tolerated, concerns persist regarding its hepatic and metabolic safety. Prospective real-world data characterizing the longitudinal hepatic and metabolic trajectories following DTG initiation in antiretroviral therapy (ART)-naïve South Asian PLHIV remain limited. Therefore, we conducted a prospective study to determine the incidence and grading of liver enzyme elevation (LEE) and characterize the longitudinal trajectories of alanine aminotransferase (ALT), anthropometric, and glycemic parameters over six months in ART-naïve PLHIV initiated on the TLD regimen. Methodology We conducted a six-month prospective cohort study and followed 101 ART-naïve adult PLHIV initiated on the TLD regimen at a tertiary care hospital in Bengaluru, India. Serum ALT, weight, body mass index (BMI), waist circumference, and random blood sugar (RBS) were measured at baseline and at one, two, three, and six months. Repeated-measures analysis of variance (rmANOVA) was used to assess longitudinal trends; paired-samples t-test compared baseline and six-month values for waist circumference; chi-square tests examined categorical associations. Results All 101 enrolled participants completed the six-month follow-up. The mean age was 36.5 ± 11.2 years, and 67 (66.3%) participants were male. Any-grade LEE occurred in 22 (21.8%) participants. Mean ALT rose transiently from 26 ± 14 IU/L at baseline to a peak of 32 IU/L at one month, then declined progressively to 27 ± 17 IU/L at six months; the overall trajectory was not statistically significant (F(1.94, 192.29) = 1.114, P = 0.329). All participants with LEE remained asymptomatic; no jaundice, coagulopathy, or hepatic encephalopathy was observed in this cohort. Statistically significant increases were noted in weight +1.79 kg (F(2.02, 201.87) = 12.549, P < 0.001), and mean BMI +0.71 kg/m² (F(2.00, 199.90) = 13.117, P < 0.001). Mean RBS rose by only +1.06 mg/dL (F(3.71, 370.96) = 2.274, P = 0.066) and waist circumference by +0.17 cm (t(100) = 1.42, P = 0.159) - neither change reached statistical significance. LEE was not significantly associated with age (t(99) = 0.298, P = 0.766), sex (χ²(1) = 3.02, P = 0.082, φ = 0.17), concurrent anti-tuberculosis therapy (Fisher's exact P = 0.116), or alcohol use (χ²(1) = 0.001, P = 0.973, φ = 0.003). Conclusions In ART-naïve South Indian PLHIV initiating DTG-based cART, LEEs were relatively common but were predominantly mild, asymptomatic, and self-limited. LEE was characterized by an early rise in ALT followed by a spontaneous decline in most cases by six months despite uninterrupted therapy, a pattern that may reflect hepatic adaptation. In contrast, body weight and BMI increased progressively throughout follow-up, suggesting that hepatic and metabolic responses to DTG may follow distinct trajectories. Overall, ALT elevations were predominantly mild and self-limited, indicating favorable hepatic tolerability of DTG-based cART in this cohort while highlighting the need for continued metabolic monitoring.
 Maxillofacial injuries represent a significant burden in trauma care, largely driven by the increasing incidence of motor vehicle collisions. This study evaluates the demographic profiles, aetiologies, fracture patterns, concomitant injuries, and clinical outcomes of surgically managed maxillofacial trauma at a tertiary care centre in North India.  This retrospective observational study analysed patients aged >15 years undergoing surgical intervention for acute maxillofacial fractures between January and December 2024. Data regarding demographics, mechanism of injury, fracture site, associated trauma, and postoperative complications were extracted from hospital records and analysed using IBM SPSS Statistics for Windows, Version 27 (Released 2020; IBM Corp., Armonk, New York).  Of the 152 patients, 96.05% (n = 146) were male, with the most prevalent age group being 21-30 years (26.32%). Road traffic accidents (RTAs) were the primary aetiology (80.26%). Panfacial fractures were the most common injury pattern (53.95%). Concomitant head injuries were present in 36.84% of cases. The average hospital stay was 5.6 days, with aesthetically unpleasing scars being the most frequent postoperative concern.  The high prevalence of RTA-induced panfacial fractures among young males highlights an urgent need for stricter enforcement of road safety protocols, speed regulations, and the use of protective gear in the North Indian region.
Chronic cough in patients with systemic lupus erythematosus can be difficult to evaluate, especially when initial testing is unrevealing. We report the case of a 33-year-old woman with long-standing systemic lupus erythematosus, biopsy-proven lupus nephritis, prior extrapulmonary pericardial tuberculosis, and no active or passive smoking exposure who developed a persistent dry cough for six months. She was initially treated for gastroesophageal reflux disease with pantoprazole, without meaningful relief. Chest radiography and swallowing assessment were normal. Initial pulmonary function testing in July 2023 was formally interpreted as moderate obstructive airways disease, mild parenchymal restriction, and a moderately severe diffusion defect, without a significant bronchodilator response. High-resolution volumetric computed tomography of the chest with dynamic airway assessment showed no emphysema, bronchiectasis, interstitial lung disease, tracheomalacia, or acute cardiopulmonary process. Her cough improved substantially after inhaled therapy with albuterol and budesonide/glycopyrrolate/formoterol fumarate. Repeat pulmonary function testing in October 2023 showed improved spirometric values, but the forced expiratory volume in one second/forced vital capacity ratio remained preserved, and hemoglobin-adjusted diffusing capacity remained reduced at 64% predicted. This case highlights a diagnostic pitfall: inhaler-responsive chronic cough and a pulmonary function report suggesting obstruction should be evaluated together with post-bronchodilator spirometry, diffusing capacity, imaging, and exposure history. In systemic lupus erythematosus, a persistent cough may be associated with clinically relevant pulmonary function abnormalities even when chest imaging is unrevealing.
Background Urinary tract infections (UTIs) represent a major global health challenge, with the rise of multidrug-resistant (MDR) uropathogens significantly complicating empiric treatment and increasing medical costs. The objective of this study was to determine the local burden of MDR UTIs and the patient characteristics associated with it, characterize the causative pathogens, and describe their antimicrobial susceptibility patterns in a community hospital setting. Methods A retrospective cross-sectional study was conducted at Phelps Hospital in Sleepy Hollow, NY, USA, utilizing 392 urine samples collected from inpatients between February and May 2026. MDR status was defined as acquired non-susceptibility to at least one agent in three or more antimicrobial categories. Bacterial isolates were identified using automated methods, followed by antimicrobial susceptibility testing interpreted according to Clinical and Laboratory Standards Institute (CLSI) 2022 guidelines. Results Among 286 symptomatic patients, 70 (70/286; 24.47%) had MDR UTIs. Escherichia coli was the predominant pathogen (48/70 samples; 68.6%), of which 47.91% (23/48 samples that grew Escherichia coli) were extended-spectrum beta-lactamase (ESBL)-producing. A significant finding was that among the MDR isolates that grew Enterococcus, all were vancomycin-resistant. The most common clinical characteristics associated with MDR infection were prior antibiotic use within six months (42/70; 60%) and hospitalization within the previous year (41/70; 58.7%). Susceptibility data revealed high activity of carbapenems and tigecycline against the majority of MDR gram-negative isolates in this cohort. Conversely, high resistance rates were observed for fluoroquinolones and trimethoprim-sulfamethoxazole (TMP-SMZ), making them unreliable for empiric use in this population. Conclusion The high prevalence of ESBL-producing Enterobacterales and vancomycin-resistant enterococci (VRE) in this cohort emphasizes the critical need for routine urine culture and susceptibility testing to guide effective therapy. Implementing antibiotic stewardship programs and utilizing local resistance data are essential to prevent the further emergence of resistance and to preserve the efficacy of last-resort antibiotics.
The triangle of Brocq and Mouchet is a clinically significant arteriovenous region on the anterior surface of the heart, formed by the anterior interventricular artery (AIV), circumflex artery (Cx), and great cardiac vein (GCV). Despite its relevance in cardiac surgery and interventional cardiology, detailed anatomical characterization of this region remains limited. This study aimed to evaluate the presence, morphological variations, and vascular relationships of the triangle of Brocq and Mouchet in human cadaveric hearts, with emphasis on its clinical significance.  A descriptive cadaveric study was conducted on 30 adult human hearts obtained from routine anatomical dissections at Sri Ramachandra Institute of Higher Education and Research (Deemed to be University) (SRIHER (DU)). Specimens with intact coronary vasculature were included. Detailed microdissection was performed to identify the LAD, Cx, and GCV. The arteriovenous triangle was first assessed for its presence and morphology. Based on the anatomical configuration formed by the AIV, Cx, and GCV, the triangle was classified into five morphological types: closed, inferiorly open, superiorly open, completely open, and absent. The relationship of the GCV with the LAD and Cx was recorded as superficial, deep, crossing, or parallel. Additional arterial components, including median and diagonal branches, were documented.  The triangle was present in 28 (93.3 %) specimens. The closed type was the most frequent pattern (15 (50%) specimens), followed by the inferiorly open type (12 (40%) specimens), the superiorly open type (1 (3.3%) specimen), and absence of the triangle (2 (6.7%) specimens). No completely open type was observed. The GCV was predominantly deep to the LAD (16 (59.3%) specimens) and superficial to the Cx (21 (72.4%) specimens), with mixed relationships observed in 15 (50%) specimens. Additional arterial components were identified as the median artery in 11 (39.3%) specimens and diagonal branches in 8 (28.6%) specimens, with most structures located superficial to the GCV in 17 (60.7%) specimens. The triangle of Brocq and Mouchet showed high prevalence and considerable anatomical variability in morphology and vascular relationships. These variations have important implications for coronary interventions, including catheterization, coronary artery bypass grafting (CABG), and electrophysiological procedures. A comprehensive anatomical understanding of this region is essential for improving procedural safety, minimizing iatrogenic complications, and supporting better clinical outcomes.
Multiple myeloma is a malignancy characterized by the monoclonal proliferation of plasma cells, primarily within the bone marrow. While it predominantly remains confined to the marrow, extramedullary plasmacytomas, though rare, can occur in various anatomical sites. This report presents three cases of extramedullary plasmacytomas in uncommon locations (the thyroid, pleura, and skin) in patients with an established diagnosis of multiple myeloma. Each case was diagnosed using histopathological examination and immunohistochemical profiling. The thyroid plasmacytoma was identified through thyroid lobectomy, while pleural and cutaneous involvements were detected via biopsy of a pleural and a subcutaneous mass, respectively. These cases highlight the diversity of extramedullary plasmacytoma manifestations and underscore the importance of considering multiple myeloma in the differential diagnosis when atypical extramedullary tumors are identified.
Generative artificial intelligence (AI) (e.g., ChatGPT and Google Gemini) is exceptionally useful in the educational field for learning new concepts. However, besides its benefits, it also introduces the risk of pathological dependence on AI. Hence, this study aims to evaluate the prevalence of AI dependency and its association with critical thinking. A cross-sectional study was conducted at a government medical college in Tamil Nadu. The study population comprised undergraduate medical students. Data were collected using a structured digital questionnaire that consisted of validated Generative AI Dependency and Critical Thinking Disposition Assessment Questionnaire (CTDAQ-20) scales. Statistical analysis included non-parametric group comparisons, Spearman's rank correlation, and multiple linear regression. Among the 722 participants, the prevalence of Generative AI usage was 695 (96.3%). Among users (n=695), the median AI dependence score was 2.1 (IQR: 1.6-2.7), with males having higher dependence than females (p=0.019) and final-year students reporting higher dependence than students in other years (p<0.001). The overall median critical thinking score was 71.0 (IQR: 64.0-77.0), with female students scoring higher (72 vs. 69; p<0.001), and first-year students having better critical thinking scores than students in other years (p=0.031). Overall, AI dependence had a significant inverse correlation with overall critical thinking (rho=-0.248, p<0.001), and multiple linear regression confirmed that higher AI dependence (B=-1.487, p<0.001) and increasing age (B=-0.868, p=0.008) were associated with lower critical thinking. Generative AI usage is ubiquitous among medical students. However, greater dependence on AI is independently associated with diminished critical thinking, particularly among final-year and male students. Therefore, it is hypothesized that the medical curriculum should consider incorporating assessment methods that require active learning and clinical reasoning, such as objective structured clinical examinations (OSCEs) and direct observation of procedural skills (DOPS), rather than relying primarily on traditional theory-based examinations, and should promote AI literacy that supports the use of AI as an adjunct rather than a replacement for human cognition.
Direct oral anticoagulant (DOAC)-associated spontaneous spinal epidural haematoma (SSEH) is an uncommon but potentially devastating haemorrhagic complication that can cause acute spinal cord compression. Current evidence is limited to case reports, case series, and accompanying narrative reviews, with no comprehensive systematic synthesis of the available evidence. A systematic review was conducted in accordance with PRISMA 2020 guidelines. MEDLINE via PubMed was searched from database inception to March 2026 using predefined search terms, with additional studies identified through backward citation searching. Studies reporting atraumatic SSEH in adults receiving DOACs were included. Traumatic, iatrogenic, and non-epidural haemorrhages were excluded. Data extracted included patient demographics, DOAC type, clinical presentation, diagnostic pathway, management, and neurological outcomes. A descriptive synthesis was performed. A total of 17 studies comprising 21 patients met the inclusion criteria. Rivaroxaban and apixaban were the most frequently implicated DOACs. Patients typically presented with acute neck or back pain followed by rapidly progressive neurological deficits, with several cases initially mimicking acute stroke. MRI was the most frequently utilised imaging modality, while CT also identified the haematoma in several patients, either alone or before subsequent MRI. Management was predominantly surgical decompression, although four patients were managed conservatively. Complete or partial neurological recovery was reported in 18/21 patients. DOAC-associated SSEH is a rare but time-critical neurological emergency. Early recognition, prompt imaging, and timely intervention remain fundamental to optimising neurological outcomes. As the use of DOACs continues to increase, clinician awareness of this uncommon complication is essential to facilitate early diagnosis and appropriate management.
Traditional classifications of Parkinson's disease (PD), such as tremor-dominant and postural instability/gait difficulty (PIGD) types, are useful for prognosis but offer limited guidance for individualized interventions. This case series descriptively explores clinically observed movement patterns, referred to as rigid, loose, and hemi types, to illustrate how rehabilitation strategies were adapted for each case. Three individuals with PD were categorized by their predominant motor presentation and completed a three-month intensive rehabilitation program. The rigid type received gait training with visual feedback and rhythmic cueing. The loose type underwent trunk- and hip-focused strengthening combined with aerobic training to improve movement control. The hemi type received laterality-focused sensorimotor training progressing from single-joint to coordinated multi-joint movements. All participants showed improvements in gait symmetry, postural control, and motor function, with reductions in the Movement Disorder Society-Unified Parkinson's Disease Rating Scale (MDS-UPDRS) Part III and Parkinson's Disease Questionnaire-39 (PDQ-39) scores and enhanced spatiotemporal gait parameters. A movement-based perspective may serve as a practical clinical framework for considering individualized rehabilitation strategies. These findings should be interpreted as exploratory and hypothesis-generating.
The competition for highly desired residency training positions in certain medical specialties has become intense. Annually in the US, there are multiple instances of an inability of the National Residency Match Program (NRMP) to accommodate each medical student's desire for a seat in their residency of interest. Residency applicant interviews since the COVID-19 pandemic are virtual, initially for disease prevention, but now for cost savings (to both the institution and the applicants). This intense competition for positions has led to sophisticated measures by some applicants to manipulate the system by use of artificial intelligence robots (AI bots) during these virtual interviews. These AI bots gather information quickly in response to an interviewer's question and allow the applicant to seamlessly respond. Here, there is not only a consideration of cheating during the interview, but a question of whether such behavior will affect the critical thinking abilities of future physicians. Academic misbehavior through use of AI during a residency interview may portend dishonesty in a successful applicant's future medical practice. We present this commentary as a cautionary tale to those involved in the selection process regarding residency training slots.