Current Clinical and Medical Education

Early versus Late Tracheostomy in a Suburban Population: Clinical Profile, Complications, and Outcomes

Arjun Panicker — 2026-04-02

Background: Tracheostomy is one of the most frequently performed procedures in intensive care units (ICUs). Despite its common use, the optimal timing, patient selection, and impact on outcomes remain debated. There is limited data on tracheostomy practices in suburban Indian populations.

Aim: To study the clinical profile, indications, complications, and outcomes of tracheostomised patients in a suburban population.

Materials and Methods: This observational study included 50 patients who underwent surgical tracheostomy between January 2023 and January 2026 at Rajalakshmi Medical College, Sriperumbudur, Tamil Nadu, India. Data were collected on demographic profile, primary diagnosis, indication for tracheostomy, type and timing of procedure, duration of mechanical ventilation, ICU and hospital stay, complications, and outcomes at discharge and three months. Statistical analysis was performed using chi-square test, Student’s t‑test, and ANOVA; p<0.05 was considered significant.

Results: The mean age was 44.22±19.83 years, with male predominance (76%). Head trauma was the most common indication (58%). Early tracheostomy (≤7 days) was performed in 74% of patients and was associated with significantly shorter duration of mechanical ventilation (3.35±2.08 vs. 14.61±7.03 days), ICU stay (7.2±5.3 vs. 24.3±4.2 days), and hospital stay (24.97±19.59 vs. 41±15.36 days) compared to late tracheostomy (>7 days). Complication rates were lower in the early group (8.10% vs. 46.15%). At three months, 64.86% of early tracheostomy patients improved, whereas 61.53% of late tracheostomy patients expired (p=0.0001).

Conclusion: Early tracheostomy (≤7 days) is associated with reduced mechanical ventilation duration, shorter ICU and hospital stays, fewer complications, and improved three-month survival compared to late tracheostomy. In patients with an established need for prolonged airway support, earlier intervention is more rewarding than delayed management.

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Comparative Efficacy of Dexmedetomidine as an Adjuvant to Intrathecal Hyperbaric Levobupivacaine versus Ropivacaine in Spinal Anaesthesia: A Randomized Controlled Trial

Atul Kumar Singh — 2026-04-06

Background and Aims: The selection of optimal local anaesthetic and adjuvant combinations in spinal anaesthesia significantly influences clinical outcomes, particularly regarding block characteristics, hemodynamic stability, and postoperative analgesia. The objective of our study was to compare the efficacy and safety of dexmedetomidine as an adjuvant to intrathecal hyperbaric levobupivacaine versus ropivacaine in adult patients undergoing elective surgery.

Methods: A prospective, randomized, single-blind study was conducted involving 60 adult patients (ASA I-II) scheduled for elective surgeries under spinal anaesthesia. Participants were randomly allocated to receive either levobupivacaine 15 mg plus dexmedetomidine 10 μg (Group L, n=30) or ropivacaine 15 mg plus dexmedetomidine 10 μg (Group R, n=30). Primary outcomes included onset and duration of sensory and motor blockade. Secondary outcomes encompassed postoperative analgesia duration, hemodynamic parameters, and adverse events.

Results: Onset times for sensory (92.27±12.05 vs 93.57±11.16 seconds, p=0.666) and motor (326.93±19.03 vs 327.60±18.68 seconds, p=0.892) blocks were comparable between groups. Group R demonstrated significantly longer sensory block duration (334.83±18.73 vs 280.17±14.35 minutes, p=0.001) and postoperative analgesia (513.67±35.04 vs 416.50±37.65 minutes, p=0.001). Group L exhibited prolonged motor block duration (117.33±6.23 vs 111.47±5.88 minutes, p=0.001). Hemodynamic stability was maintained in both groups with minimal adverse events. Hypotension occurred in 16.7% of Group L and 20.0% of Group R patients (p=0.739), with no cases of bradycardia or other serious complications.

Conclusions: Both dexmedetomidine combinations provided safe and effective spinal anaesthesia with rapid onset characteristics. Ropivacaine-dexmedetomidine offers superior postoperative analgesia and sensory block duration, making it preferable for procedures requiring extended pain control. Levobupivacaine-dexmedetomidine provides longer motor blockade, suitable for surgeries demanding prolonged immobilization. The choice between combinations should be tailored to specific surgical requirements and patient recovery goals.

Keywords: Dexmedetomidine, Levobupivacaine, Ropivacaine, Spinal anaesthesia, Postoperative analgesia, Regional anaesthesia.

Frequency and Risk Factors of Red Cell Alloimmunization in Transfused Patients with Sickle Cell Disease and Sickle Cell–β Thalassemia: A Three-Year Retrospective Study from a Tertiary Care Centre.

Tenzing Yutchola Bhutia — 2026-05-01

Background: Red cell alloimmunization is a clinically significant complication of repeated transfusions in sickle haemoglobinopathies. Comparative data from eastern India remain limited.

Objectives: To determine the frequency of alloimmunization in transfused patients with sickle cell disease (SCD) and SCD with β-thalassemia, and to identify associated demographic and transfusion-related risk factors.

Materials and Methods: A retrospective observational study was conducted at KIMS, Bhubaneswar, from October 2022 to October 2025. A total of 148 patients (131 SCD, 17 SCD+β-thalassemia) with a clearly recorded indirect Coombs test (ICT) result were analysed. Demographic and transfusion data were retrieved from blood bank registers. Statistical analysis included chi-square, Fisher's exact, Mann-Whitney U tests, and binary logistic regression.

Results: The overall alloimmunization frequency was 12.2% (18/148). Rates were 11.5% in SCD and 17.6% in SCD+β-thalassemia (p = 0.437). Alloimmunization increased significantly with transfusion burden, from 2.3% after one transfusion to 31.6% beyond ten transfusions (χ² = 10.23, p = 0.017). On multivariable regression, age was the only independent predictor (OR = 1.045/year, 95% CI 1.008–1.085, p = 0.018).

Conclusion: Alloimmunization affects approximately one in eight transfused patients with sickle haemoglobinopathies at this centre. Transfusion burden and age are the principal determinants. Extended antigen phenotyping and prophylactic Rh/Kell matching are strongly recommended, particularly for patients anticipated to receive more than five lifetime transfusions.

Assessment of Diabetic Retinopathy And Its Association With Glycemic Control In Newly Diagnosed Diabetes Patients

Pradeep Misra — 2026-05-08

Introduction: Diabetes Mellitus Type 2 is a major health concern worldwide, with a high number of cases resulting in various types of complications affecting target organs like Brain, Heart, Kidneys, and Eyes with the eyes presenting as Diabetic Retinopathy (DR), which is nowadays becoming a reason of preventable blindness. Low glycemic control, ageing, and delay in the diagnosis have enhanced the risk of DR. The study highlights the significance of the screening process and the accurate management to help prevent the effects of DR

Methodology: This cross-sectional, hospital-based observational study was carried out over a one-year period in a tertiary care center in India to evaluate Diabetic Retinopathy and its association with glycemic control. 80 newly diagnosed adult patients with type-2 Diabetes Mellitus were enrolled after obtaining institutional ethical approval and informed consent. Participants underwent detailed clinical assessment, including demographic profiling, laboratory evaluation of glycemic status using HbA1c levels, and comprehensive ophthalmological examination for the detection and grading of Diabetic Retinopathy. Patients were categorized into retinopathy and non-retinopathy groups. Statistical analyses were performed to assess associations and identify predictors of Diabetic Retinopathy among newly diagnosed diabetic patients.

Result: Among the 80 newly diagnosed type-2 diabetic patients, Diabetic Retinopathy was observed in 44% (35/80), predominantly mild non-proliferative disease (40%), followed by moderate (31%), severe non-proliferative (20%), and proliferative retinopathy (9%). Age and gender did not differ significantly between groups (p=0.21; p=0.81). The duration of diabetes was longer in the retinopathy group (2.5 ± 0.4 vs 1.5 ± 0.3 months; p=0.058) but not significantly different. Multivariate analysis identified diabetes duration (OR 1.14; p<0.001), HbA1c (OR 1.28; p=0.0256), and age (OR 2.08; p<0.05) as significant predictors.

Conclusion: The study concluded that the Diabetic Retinopathy is a common finding even among newly diagnosed type 2 Diabetes Mellitus patients and is significantly associated with poor glycemic control. Higher HbA1c levels and increasing duration of diabetes emerged as independent predictors of Diabetic Retinopathy.

Clinical Profile and Determinants of Dry Eye Disease in Adults

Pradeep Misra — 2026-05-08

Introduction: Dry Eye Disease (DED) is the disorder which is identified with tear film instability, ocular surface inflammation, and neurosensory dysfunction, which results to discomfort and visual impairment. The occurrence hasvariation among different populations and enhances with age, lifestyle factors and different systemic disorders. Analysis of the clinical profiles and determinants are important for the diagnosis and management.

Methodology: This cross-sectional study conducted over one year in a tertiary care hospital in India evaluated the clinical profile and determinants of dry eye disease. Among 150 patients aged above 20 years attending the Ophthalmologyoutpatient department, 90 were diagnosed with dry eye. Detailed demographic, clinical, and systemic data were collected following informed consent. Diagnosis and grading were based on Schirmer’s test I, tear break-up time (TBUT), tear film thinning time (TTT), and tear meniscus height (TMH).

Results: Across 90 dry eye cases, the highest age-specific prevalence was observed in the 50–59-year group (26.67%), followed by 40–49 years (20.00%) and 60–69 years (18.89%), while younger adults aged 20–29 years contributed only 5.56%. Symptomatically, burning sensation (93.75%), blurred vision (92.11%), redness (90.00%), and itching (89.47%) predominated. Mild to moderate level of severity was observed with significant reduction in the quantity and the quality of tear for different parameters like Schirmer’s I, TBUT, tear meniscus height, and tear film thinning time.

Conclusion: The study had concluded that dry eye disease was commonly prevalent among mid aged individuals, associated with ocular surface symptoms like itching and other systemic comorbidities were present. Mostly cases varied from mild to moderate level of severity of dry eyes.

A comprehensive study on the morphometric analysis of the human femur with anatomical and clinical correlations

Rajeshwari Sadashiv Bhosale — 2026-05-09

Introduction: The femur bone is the longest and strongest bone, which is crucial for locomotion, transmission of weight and maintains stability. The morphometric characteristics are significant for the orthopaedic surgery, design of the prosthesis and identification of forensic details. The study aims to evaluate the femoral measurements and the establishment of the anatomical variations with clinical significance.

Method: This was a descriptive cross-sectional study which was conducted among 50 dry human femora, where the intact bones were only included. The digital Vernier caliper was used to take measurements, an osteometric table, and a goniometer. Data analysis was done by SPSS. The descriptive statistics and correlation analysis were performed with p < 0.05.

Result: The study findings showed that the diameter of the head and the neck parameter showed moderate variation, while the length of the femur showed low variation. The positive correlations were noted between the head diameter, neck diameter, intertrochanteric line length and the length of the femur. The regression model showed moderate fit with R² = 0.271, p = 0.001, along with 27.1% variance.

Conclusion: The study concluded that the significant morphometric variation in the human femur bone, with the diameter of the head as 41.83 ± 3.12 mm and the neck parameter showed moderate dispersion, while low variation was noted for the length of the femur.

Drug Utilization patterns and medication adherence in the management of Rheumatoid Arthritis

Mukulesh Gupta — 2026-05-12

Introduction: Rheumatoid arthritis is a continuing, systemic autoimmune disorder characterised by persistent joint inflammation leading to cartilage destruction, bone erosion, and functional disability. Optimal disease management depends on appropriate drug utilisation, rational prescribing, and sustained medication adherence. To assess the drug utilisation patterns, combination therapy tendencies, and adverse drug reactions among patients with rheumatoid arthritis, and to assess adherence to pharmacological management methods.

Methods: The present study is a cross-sectional study done at a tertiary care hospital in India. The study was done on the drug utilization pattern among 120 patients suffering from arthritis, aged between 18 and 80 years. The study was done for a period of one year. The study was done using Case Record Forms. The study was analyzed using SPSS software version 27. Student’s t-test and Chi-square test were done at a p-value of <0.05.

Results: The majority of patients were female (67.5%) and belonged to the 36–50 years age group (45%). Oral administration was the most common route (95%). Preferential COX-2 inhibitors such as diclofenac (33.3%) and aceclofenac (30.3%) were the most prescribed NSAIDs. Among DMARDs, methotrexate monotherapy (23.2%) was frequent, while combination therapy (59.7%) dominated overall. The use of calcium, vitamin D, and multivitamins was notable as supportive therapy. Adverse drug reactions occurred in 21.9% of patients, mainly presenting as gastric discomfort (12.2%) and mild gastrointestinal complaints.

Conclusion: The study concluded that oral medications, preferential COX-2 inhibitors, and combination DMARD regimens constitute the predominant therapeutic approaches in arthritis care, guided by their efficacy and clinical acceptance.

Association of Neutrophil-to-Lymphocyte Ratio with Severity of Coronary Artery Disease in Patients Undergoing Coronary Angiography

S. S. Mohanty — 2026-05-19

Background: Coronary artery disease (CAD) remains the leading cause of global mortality. The neutrophil-to-lymphocyte ratio (NLR), derived from routine blood counts, is a simple inflammatory index. Its correlation with angiographic CAD severity in Indian patients remains underexplored.

Objectives: To evaluate the association of NLR with angiographic severity of CAD; to compare NLR across single-vessel (SVD), double-vessel (DVD), and triple-vessel (TVD) disease groups; and to assess NLR utility in predicting high SYNTAX score.

Methods: 250 consecutive patients undergoing elective coronary angiography were enrolled. NLR was calculated from admission complete blood count (CBC). Vessel involvement and SYNTAX score were recorded. Statistical analyses included one-way ANOVA, Pearson correlation, ROC curve analysis, and binary logistic regression.

Results: Of 242 analysable patients, 55 had no obstructive CAD (control), 75 had SVD, 64 DVD, and 48 TVD. Mean NLR rose significantly: 1.82 ± 0.61 (control), 2.74 ± 0.83 (SVD), 3.91 ± 1.12 (DVD), 4.73 ± 1.38 (TVD) — p < 0.001. NLR correlated strongly with SYNTAX score (r = 0.68, p < 0.001). At NLR ≥ 3.2, sensitivity was 78.4% and specificity 81.2% for high SYNTAX score (≥33). Multivariate analysis confirmed NLR as an independent predictor of TVD (OR 3.42; 95% CI 1.87–6.26; p < 0.001).

Conclusions: NLR correlates significantly with angiographic CAD severity and independently predicts multivessel disease. It may serve as a simple, inexpensive pre-angiographic risk stratification tool.

A Study to Assess NT-proBNP Levels in Constrictive Pericarditis and Restrictive Cardiomyopathy: Diagnostic and Prognostic Implications

Satish Suryavanshi — 2026-05-19

Background: Differentiating constrictive pericarditis (CP) from restrictive cardiomyopathy (RCM) remains one of the most challenging diagnostic dilemmas in cardiology. Both conditions share overlapping haemodynamic and echocardiographic features, yet their management strategies and prognoses differ fundamentally. N-terminal pro-B-type natriuretic peptide (NT-proBNP), a biomarker of ventricular wall stress, may offer a non-invasive means to distinguish between these conditions and assess disease severity.

Objectives: To measure and compare NT-proBNP levels in patients with confirmed CP, confirmed RCM, and matched healthy controls; to evaluate NT-proBNP as a discriminatory biomarker between CP and RCM; and to correlate NT-proBNP with echocardiographic, haemodynamic, and functional parameters.

Methods: This prospective, case-control study enrolled 90 participants: 30 with confirmed CP, 30 with biopsy-proven RCM, and 30 healthy age- and sex-matched controls. Serum NT-proBNP was measured by electrochemiluminescence immunoassay (ECLIA). Comprehensive echocardiography, cardiac catheterisation (where indicated), and cardiac MRI were performed. Statistical analyses included Mann-Whitney U test, Pearson correlation, ROC curve analysis, and binary logistic regression.

Results: Median NT-proBNP was 138 pg/mL (IQR 112–174) in controls, 2710 pg/mL (IQR 2150–3380) in CP, and 4050 pg/mL (IQR 3480–4820) in RCM (p < 0.001 for all comparisons). NT-proBNP was significantly higher in RCM than CP (p < 0.001). AUC was 0.91 (CP vs controls) and 0.88 (RCM vs controls). At cut-off 3500 pg/mL for RCM vs CP: sensitivity 83.3%, specificity 80.0%. NT-proBNP correlated with NYHA class (r = 0.74 in CP; r = 0.81 in RCM), E/e’ ratio (r = 0.68), and invasive filling pressures (r = 0.72; all p < 0.001). NT-proBNP ≥ 3500 pg/mL independently predicted RCM over CP (OR 6.2; 95% CI 2.4–15.8; p < 0.001).

Conclusions: NT-proBNP is markedly elevated in both CP and RCM, but substantially higher in RCM. It correlates with functional status and haemodynamic severity. NT-proBNP ≥ 3500 pg/mL may serve as a useful adjunct biomarker for differentiating RCM from CP, warranting validation in larger prospective cohorts.

Platelet-Rich Plasma Versus Corticosteroids in the Management of Chronic Tendinopathies: A Randomized Comparative Study Across Three Anatomical Sites

Sujit Kumar Singh — 2026-05-22

Background:
Chronic tendinopathies such as Achilles tendinitis, lateral epicondylitis, and De Quervain’s tenosynovitis often respond poorly to conservative treatment, leading to persistent pain and impaired function. Corticosteroid injections, though commonly used, offer only transient relief with high recurrence rates. Platelet-rich plasma (PRP), an autologous biologic product rich in growth factors, is emerging as a regenerative alternative with longer-lasting benefits.

Objective:
To compare the efficacy and safety of PRP versus corticosteroid injections in patients with chronic tendinopathies, evaluating outcomes across pain intensity, functional improvement, patient satisfaction, and recurrence over six months.

Methods:
A prospective, randomized controlled study was conducted on 60 patients diagnosed with chronic tendinopathy, equally divided into PRP (n = 30) and corticosteroid (n = 30) groups. PRP was prepared using a double-spin method under sterile conditions. After baseline assessment, all participants received ultrasound-guided injections, and follow-up assessments were conducted at 1, 3, and 6 months. Outcomes included pain intensity (using a Visual Analog Scale), functional performance (condition-specific score normalized to a 0–100 scale), patient satisfaction (evaluated with a 5-point Likert scale), recurrence, and adverse events.

Results:
At six months, the PRP group showed significantly lower pain scores (VAS: 2.17 ± 1.01) compared to the corticosteroid group (3.49 ± 0.77; p < 0.001). Functional improvements were greater in the PRP group, with scores averaging 88.07 ± 9.25 versus 81.96 ± 6.01 in the corticosteroid group. Satisfaction was higher following PRP therapy, with 90% of patients rating their experience favorably, compared to 46.7% in the corticosteroid group. Although symptom recurrence was less common in the PRP group (10.0% versus 23.3%), this difference was not statistically significant. Both treatments were well tolerated with only minor, self-limiting adverse effects.

Conclusion:
PRP therapy demonstrated superior outcomes compared to corticosteroids in the management of chronic tendinopathies, including greater pain relief, enhanced functional recovery, and higher patient satisfaction, with a favorable safety profile and reduced recurrence trend. PRP should be considered a reliable and effective injectable option for long-term management of chronic tendinopathies across anatomical sites.

Sedation Profile and Safety of Intravenous Dexmedetomidine for Procedural Sedation During MRI Brain in Paediatric Patients: A Prospective Observational Study

Thengujam Ashapriya Devi — 2026-05-22

Background: Procedural sedation for MRI brain in children demands an agent ensuring complete immobility, respiratory preservation, and rapid recovery. Dexmedetomidine, a selective α-2 adrenoceptor agonist producing natural sleep-like sedation, represents a compelling candidate for this indication.

Objectives: To assess the sedation profile and safety of intravenous dexmedetomidine (loading dose 1 mcg/kg over 10 minutes + maintenance 0.7–1.0 mcg/kg/hr) for procedural sedation during MRI brain in paediatric patients aged 1–10 years.

Methods: This prospective observational study enrolled 52 paediatric patients (ASA Grade I–II). Primary outcomes included time to onset of adequate sedation (Ramsay Sedation Score ≥ 4), recovery time, MRI image quality score, and requirement for propofol rescue. Serial haemodynamic parameters and adverse events were recorded at 10-minute intervals. Statistical analysis employed Friedman test, Wilcoxon signed-rank test, and Kruskal-Wallis test; p < 0.05 was considered significant.

Results: Mean age was 5.83 ± 2.17 years. Sedation onset was 6.59 ± 0.99 minutes with recovery at 11.25 ± 1.61 minutes. Optimal MRI quality score 1 was achieved in 47 patients (90.4%); 5 patients (9.6%) required propofol rescue and achieved MRI quality score 2. Procedural success rate was 100% with zero repeat scans. Heart rate declined significantly from 111.58 ± 9.00 to 94.92 ± 8.18 bpm at 20 minutes (Friedman χ² = 312.0, p < 0.001). SpO₂ remained clinically stable throughout the procedure, with no desaturation events. Adverse events were limited to 2 cases (3.8%) of self-limiting bradycardia.

Conclusion: Intravenous dexmedetomidine provides effective, safe, and rapidly reversible sedation for paediatric MRI brain with a 100% procedural success rate and no observed respiratory adverse events.

Neonatal Rotavirus-Associated Leukoencephalopathy: An 11-Case Series Identifying a Stereotyped MRI Diffusion Pattern Independent of Stool Viral Detection

2026-05-19

Background: Fifth-day seizures in otherwise well term neonates have been associated with rotavirus-associated leukoencephalopathy, but diagnosis is often limited by stool-based testing, particularly when gastrointestinal symptoms are absent or minimal. Objective: To describe the clinical, laboratory, electroencephalographic, and MRI characteristics of neonates with presumed rotavirus-associated encephalopathy and to assess whether a stereotyped DWI/ADC pattern can support diagnosis when stool tests are negative. Methods: We retrospectively reviewed 11 term neonates who presented with seizures on days 4-6 of life, had no evidence of perinatal asphyxia, and underwent brain MRI with diffusion-weighted imaging and apparent diffusion coefficient mapping after sepsis and metabolic evaluation. Stool rotavirus testing was performed using antigen enzyme immunoassay and/or reverse-transcription PCR. Results: The cohort included 7 female and 4 male neonates. Seizures began on day 4 in 8 infants and day 5 in 3; multifocal clonic seizures predominated (7/11). Gastrointestinal symptoms were present in only 1 infant. Sepsis screens, electrolytes, calcium, glucose, and CSF results were non-contributory. Stool testing confirmed rotavirus in 6/11 infants (5 PCR-positive, 1 antigen-positive), while 5 were stool antigen-negative. All 11 infants demonstrated symmetric restricted diffusion involving the periventricular white matter and corpus callosum, with internal capsule involvement in 3/11. All were seizure-free at discharge; length of stay ranged from 10 to 15 days (median 13). Conclusion: In this homogeneous fifth-day seizure cohort, the MRI diffusion signature was more consistent than stool viral detection and should prompt consideration of rotavirus-associated neonatal leukoencephalopathy even when stool testing is negative.