Aarupadai Veedu Medical College & Hospital

Introduction: Cardiovascular disease (CVD) is a leading cause of morbidity and mortality worldwide and dyslipidemia is the major risk factor for CVD. Aim: The aim of the study was to assess the real-world treatment patterns associated with the use of rosuvastatin + ezetimibe combination therapy for lipid management. Methods: This retrospective multicentric, noncomparative, nonrandomized, observational real-world study was conducted at multiple healthcare centers in India. Patients aged ≥18 years (either sex), with uncontrolled dyslipidemia, familial hypercholesteremia, and mixed dyslipidemias, with persistently elevated levels of low-density lipoprotein cholesterol (LDL-C) despite receiving statin therapy were included. Fasting blood LDL-C was monitored in high, very high, and extreme-risk patients. Results: A total of 1465 patients were enrolled with a mean age of 60.87 years and men predominance (67.49%). Median (range) duration of hypercholesteremia of patients was 4.00 (0.40–19.50) years. The majority of patients were on moderate-intensity statin therapy (54.68%), followed by high-intensity statin (27.37%) and low-intensity statin (17.95%). The majority of patients taking moderate-intensity statins (47.38%) had LDL-C levels between 151 and 200 mg/dL, compared to those taking low (36.50%). Combination rosuvastatin + ezetimibe therapy showed a significant reduction in mean LDL-C levels of patients using low, moderate, and high-intensity statins with a mean difference of 100.63 mg/dL, 94.24 mg/dL, and 92.00 mg/dL ( P < 0.001 each) as well as a significant reduction in LDL-C levels, total cholesterol levels, and triglycerides levels ( P < 0.001 each). Conclusion: Rosuvastatin and ezetimibe therapy was an effective and well-tolerated lipid-lowering agent, offering higher efficacy, especially in the reduction of LDL-C levels.

Objective: To evaluate the accuracy of nurse-led triage using a three-level institutional protocol in a tertiary care emergency department (ED) and identify predictors of triage discordance. Methods: This cross-sectional study included 1,249 adult ED patients. Nurse-assigned triage levels were compared with emergency physician (EP) triage, considered the gold standard. Accuracy, under-triage, and over-triage rates were calculated. Cohen's Kappa (κ) assessed agreement. Univariate chi-square (χ²) analysis was performed to identify associations between variables and triage inaccuracy, with odds ratios (OR) and 95% confidence intervals (CI) calculated from cross-tabulations. Results: Triage accuracy was 94.6%, with 4.88% over-triage and 0.48% under-triage. Agreement between nurse and EP triage was κ = 0.91 (95% CI: 0.89–0.93), indicating excellent concordance. Univariate analysis identified significant associations between over-triage and elevated respiratory rate (≥25/min; p=0.002) and elevated systolic blood pressure (≥160 mmHg; p=0.039). Under-triage was rare (n=6, 0.48%). No variables significantly predicted under-triage. Conclusion: Nurse-led triage demonstrated high accuracy and excellent agreement with emergency physicians. Over-triage occurred more often than under-triage and was strongly associated with abnormal physiological parameters. Reinforcement of vital-sign interpretation, structured training, and periodic audits may improve further accuracy in resource-limited settings. Keywords: Triage accuracy; Under-triage; Over-triage; Emergency department; Physiological predictors; Kerala

Diabetic foot ulcers (DFUs) are a severe complication of diabetes, with current standard care often failing to prevent chronic morbidity and amputation. This narrative review examines the therapeutic potential of adipose-derived stem cells (ADSCs) for DFUs treatment. ADSCs promote healing through paracrine secretion of growth factors, immunomodulation, and stimulation of angiogenesis, as demonstrated in promising preclinical and early clinical studies. We outline these mechanisms, discuss the emerging role of ADSC-derived exosomes as a potentially safer alternative, and summarize key clinical findings. However, significant challenges remain, including potential risks of tumorigenicity, donor cell variability, and a lack of standardized protocols. While ADSC therapy represents a highly promising regenerative approach for DFUs, its safety and efficacy must be firmly established through more rigorous preclinical studies and large -scale randomized controlled trails before broad clinical adoption. This review concludes that while ADSC therapy is a highly promising regenerative approach for DFUs, its translation to clinical practice necessitates further rigorous investigations to overcome existing translational barriers.

Avascular necrosis (AVN) of the hip, also known as osteonecrosis or ischemic necrosis, is cellular necrosis of bone and marrow elements. Although clinical evaluation is the first step in assessing the hip joint, imaging is fundamental for accurate diagnosis and staging of AVN. We aim to assess the role of magnetic resonance imaging (MRI) in evaluating AVN of the hip, describe imaging features, and classify AVN using various classification systems. A cross-sectional study was conducted over two years at the Department of Radiodiagnosis, Aarupadai Veedu Medical College and Hospital, Puducherry, a tertiary healthcare center situated in Southern India. The study included 50 patients referred for MRI of the hip joint with suspected unilateral or bilateral hip joint pathology, with or without pain. The participants' demographic data, clinical presentations, and MRI findings were recorded. Data were collected, and Statistical Package for the Social Sciences version 28 (IBM Corp., Armonk, NY) was used for all statistical analyses. The study comprised 50 patients, with a significant male predominance (62%, n=31) and a male-to-female ratio of 1.63:1. The mean age of the patients was 41.2 years, ranging from 20 to 63 years. Idiopathic AVN was the most common risk factor, accounting for 36% of cases, followed by alcohol consumption (32%), steroid use (28%), and trauma (8%). Notably, 34% (n=17) of the patients had a history of COVID-19 prior to AVN symptom onset. Among the 50 cases with 80 hips affected by AVN, the majority (60%, n=30) had bilateral hip involvement, while 22% (n=11) had unilateral right hip involvement and 18% (n=9) had unilateral left hip involvement. The most common chief complaint in our study was hip pain, which was present in 43 (86%) cases. According to the Association Research Circulation Osseous (ARCO) classification of AVN, we observed that stage I AVN was detected in 11 (13.75%) hips, stage II AVN in 19 (23.75%), stage IIIA AVN in 21 (26.25%), stage IIIB AVN in eight (10%), and stage IV AVN in 21 (26.25%). The ARCO classification system is superior in assessing disease severity. The modified Kerboul's angle is useful for assessing femoral head deformity. The radiologic staging of the disease is of great importance for the identification and risk stratification in pre-collapse stages, prognosis, adequate treatment planning, and post-operative follow-up.

The conventional clinical assessment of pupils & pupillometers has shown very poor interrater reliability. As a promising alternative, bedside ultrasound has emerged for pupillary assessment. Thus, we conducted a systematic review to assess ultrasound's utility and comparative effectiveness in pupillary assessment. This systematic review involved searching three major databases—PubMed, Embase, and Scopus—from inception to April 2024, using predefined search terms. Inclusion criteria comprised adult patients over 18 years undergoing ultrasound for pupillary assessment, with comparison against standard methods such as pupillometry or clinical examination. Screening and data extraction were independently conducted by two investigators (GR, SM), with data appraisal utilizing the QUADAS-2 Risk of Bias assessment tool (CRD42024540402). Among 556 identified studies, seven met inclusion criteria, encompassing 865 patients and 1141 ultrasonographic pupillary assessments. Six of these studies reported a favourable correlation or association between ultrasound and pupillometer or clinical examination. Significant findings included a substantial correlation between ultrasound and infrared video pupillometry by Farina et al. (R = 0.831, p < 0.01), by Fu et al. (Bland-Altman agreement −0.069) & Modi et al. (Interclass Correlation Coefficient = 0.93). Diagnostic accuracy for identifying Relative Afferent Pupillary Defect (RAPD) had high sensitivity and specificity reported by Ramamoorthy et al. and Schmidt et al. Our systematic review demonstrates a significant correlation/association between ultrasound and pupillometer or clinical examination for pupillary assessment. However, current evidence remains limited, and further high-quality research is needed before recommending routine use or claiming superiority over pupillometry or standard clinical assessments.

Abstract Background: Clinical and health systems research is essential for advancing global healthcare. Engaging and training medical students in research will foster lifelong evidence-based practice, particularly for the emerging healthcare workforce. This study investigates the involvement of Nigerian medical students in research, identifying key opportunities and barriers to enhance their engagement. Methods: This cross-sectional, descriptive, mixed-methods study used an online survey targeting recent graduates from 42 accredited Nigerian medical schools. A purposive sampling approach selected one federal, state, and private institution from each of Nigeria’s six geopolitical zones. Data were collected between February and June 2024 using a face-validated online questionnaire distributed via WhatsApp groups. Descriptive statistics and thematic analysis were employed to explore trends in the data. Ethical approval was obtained by the Jos University Teaching Hospital ethics review board (JUTH/DCS/IREC/127/XXXI/871), and participants provided informed consent. Results: Of the 429 respondents (270 men, 159 women) from 15 universities across all six zones, 92% participated in research during medical school. Men engaged in more research projects than women (p=0.03). Most respondents participated in two projects, usually group-based, with limited individual projects. Few had presented (20%) or published (17%) their research. Proficiency was highest in developing appropriate research methodologies (54%), while data analysis was the most challenging aspect of research (42%). Participation in research was supported by adequate mentorship for most participants (64%), whereas time constraints(74%), lack of research funding (55%), and inadequate research training (31%) were the main barriers to involvement. Regional differences were noted, with the highest participation by students in the South-South geo-political zone (98%) and the lowest in the South-West (85%). Learners from the South-West had more opportunities to present research at conferences, while those from the South-East had the fewest. Participants advocated for integrating more research opportunities into the medical curriculum, emphasising early skill development. Conclusion: There is a pressing need to enhance structured research opportunities in Nigerian medical education, especially for women. This includes expanding access to training in data analysis, increasing publication and presentation opportunities, and integrating research skills early in the curriculum while addressing barriers like time constraints. Clinical trial number: not applicable.

Pituitary tumors include neoplasms that develop in and around the sella turcica. Forty-five percent invade the cavernous or sphenoid sinus, with 15% classified as clinically aggressive. We present a case of 70-year-old female with complaints of gradual progressive defective vision in the right eye for six months. Fundus examination showed temporal pallor as an incidental finding in both eyes. Magnetic resonance imaging (MRI) of brain with orbit contrast done showed parasellar and sphenoid sinus space occupying lesion with extension into left cavernous sinus for which the patient underwent surgical excision.