Employees' State Insurance Model Hospital

Background Multidrug-resistant tuberculosis (MDR-TB) continues to pose a major challenge to TB elimination in India, where drug resistance and delayed diagnosis contribute significantly to ongoing transmission. Clustered RegularlyInterspacedShortPalindromicRepeats (CRISPR) based diagnostics have emerged as versatile tools, compared to GeneXpert, capable of detecting resistance-associated mutations with rapid turnaround and high accuracy. This study aimed to design andin silico validate Clustered Regularly Interspaced Short Palindromic Repeats-CRISPR-associated protein (CRISPR-Cas)-based guide RNAs (gRNAs) targeting major drug-resistance mutations in IndianMycobacterium tuberculosis(M. tuberculosis) isolates. Methods Whole-genome mutation profiles were analyzed using TBProfiler, and gRNAs were designed using CHOPCHOP. Off-target evaluation was performed using Cas-OFFinder andBasic Local Alignment Search Tool (BLAST). High-confidence mutations in gyrA, rpoB, katG, rpsL, embB, and ethA were selected based on prevalence in Indian isolates and WHO-defined resistance markers. Results Numerous drug resistance-associated mutations were identified in the drug-resistant tuberculosis genome isolates. The study identified six key genetic mutations identified in MTB isolates that are associated with phenotypic drug resistance, including gyrA (Asp94Gly), rpoB (Ser450Leu), and katG (Ser315Thr). For each of the six genes, the chromosome position, locus ID, mutation type, and affected amino acids were identified, and tailored guide RNAs were designed in silico. Top-ranked gRNAs demonstrated optimal GC content, high predicted cleavage efficiency, and zero off-target activity. Each resistance locus yielded multiple candidate gRNAs suitable for CRISPR-based assays. Conclusions This computational in silico analysis provides a robust panel of mutation-targeted gRNAs tailored to Indian MDR-TB genomic profiles. These findings lay a strong foundation for developing rapid, affordable CRISPR diagnostics for point-of-care detection of drug resistance. Future laboratory validation and clinical testing are essential for translation into diagnostic practice.

The prognostic significance of Her2/neu and Ki-67 expression remains insufficiently defined in urothelial carcinoma even though it constitutes a major proportion of malignancies in the male population of the United States and India. Therefore, it is of interest to evaluate Immunohistochemical (IHC) expression of HER2/neu and Ki-67 to correlate with clinicopathological parameters in thirty histologically confirmed cases of urothelial carcinoma in an Indian cohort. We show that the overexpression of HER2/neu and Ki-67 correlates positively with higher tumor grade, advanced stage and may serve as reliable prognostic biomarkers thus guiding therapeutic decision making in management of urothelial carcinoma.

Background: Shoulder pain is a frequent but under‑recognized manifestation of rheumatoid arthritis (RA), contributing substantially to disability and impaired quality of life. High‑resolution musculoskeletal ultrasound (HRUS) offers sensitive detection of structural abnormalities, while the Shoulder Pain and Disability Index (SPADI) provides patient‑reported assessment of pain and function. However, the clinical and laboratory predictors of shoulder pathology and disability in RA remain incompletely defined.Methods: In this cross‑sectional study, 105 RA patients presenting with shoulder pain were enrolled. All participants underwent HRUS evaluation of the affected shoulder(s) and completed the SPADI questionnaire. Baseline demographic and laboratory parameters were recorded. Binary logistic regression was used to identify predictors of abnormal HRUS findings and seropositivity, while linear regression analyses examined associations with SPADI total (SPADI‑T), pain (SPADI‑P), and disability (SPADI‑D) scores.Results: Abnormal HRUS findings were present in 69 patients (65.7%). Logistic regression identified lower Hb (p=0.006, OR=0.01) and higher platelet (PLT) count (p=0.016, OR=1.16) as significant predictors of abnormal HRUS findings, with erythrocyte sedimentation rate (ESR) (p=0.010) and vitamin D deficiency (p=0.050) approaching significance. Higher ESR was also correlated with higher CRP. Linear regression demonstrated that longer disease duration, lower Hb, higher PLT count, elevated random blood sugar, and higher thyroid-stimulating hormone were predictors of worse SPADI‑T scores (R²=54.4%).Conclusion: Shoulder pathology in RA is multifactorial, with anemia, thrombocytosis, systemic inflammation, metabolic derangements, and vitamin D deficiency contributing to pain and disability. HRUS abnormalities are strongly linked to hematologic and metabolic markers, while functional impairment is influenced by both inflammatory and endocrine factors.

IntroductionStroke is a major cause of global morbidity and mortality. Readability of educational material is critical for rapid clinical decision-making among healthcare professionals. UpToDate (UpToDate, Inc., Waltham, MA) is a widely used, peer-reviewed point-of-care clinical resource, while ChatGPT (OpenAI, San Francisco, CA) is an emerging AI-based educational support tool. However, a formal comparison of their linguistic accessibility has not been performed.ObjectiveTo compare the readability and linguistic complexity of educational material on stroke generated by ChatGPT (GPT-4o) versus content retrieved from UpToDate, using validated readability metrics.Design, setting, and participantsThis cross-sectional study was conducted between May 27 and June 4, 2025. ChatGPT (GPT-4o, accessed May 27, 2025) was prompted to generate educational content on stroke. A corresponding section from UpToDate (accessed May 27, 2025) was extracted. Only prose content was analyzed. Readability parameters assessed included total word count, sentence count, word/sentence ratio (average words per sentence), Flesch Reading Ease (FRE), Flesch-Kincaid Grade Level (FKGL), Simple Measure of Gobbledygook (SMOG) Index, difficult word count, and difficult word percentage. Data were analyzed using IBM SPSS v25 (IBM Corp., Armonk, NY) and R v4.3.2 (R Foundation for Statistical Computing, Vienna, Austria). The Mann-Whitney U test was used. P < 0.05 was considered statistically significant.ResultsUpToDate content was substantially longer (median = 2772 vs. 304 words; p = 0.008) and used more sentences (median = 134 vs. 23; p = 0.032) and difficult words (median = 857 vs. 88; p = 0.008) compared to ChatGPT. The word/sentence ratio (average words per sentence) was also higher (21.7 vs. 13.2; p = 0.008). However, no statistically significant differences were observed for FRE (p = 1.000), FKGL (p = 0.222), SMOG Index (p = 0.151), or difficult word percentage (p = 0.690).ConclusionsChatGPT produces shorter and more concise educational content on stroke while maintaining comparable readability to UpToDate. The lower linguistic density may enhance rapid orientation for trainees; however, the reduced depth indicates ChatGPT should supplement, not replace, established peer-reviewed resources. Future research should explore multiple medical topics, additional AI models, and assess the clinical applicability and accuracy of AI-generated content.

A 65-year-old man was admitted with left lower-limb cellulitis and an impending abscess. He was a known case of type 2 diabetes mellitus, with hemoglobin A1c (HbA1c) 7.6%, and was started on intravenous piperacillin-tazobactam. Wound debridement was carried out under local anesthesia. At admission, he had stage 1 acute kidney injury as per Kidney Disease: Improving Global Outcomes (KDIGO) criteria, which improved with supportive measures. On the 6th day of therapy, his relatives noticed a black discoloration over his tongue (Fig. 1). Examination revealed a dark coating confined to the dorsal surface of the tongue, with sparing of the tip and lateral borders. There was no associated pain or burning sensation. A diagnosis of black hairy tongue (BHT) was considered, possibly related to piperacillin-tazobactam. The antibiotic was discontinued, and the patient was advised to maintain good oral hygiene and to brush the tongue gently. The discoloration resolved completely within 1 week of these measures.

ObjectiveNon-communicable diseases (NCDs) remain the leading cause of mortality in India, imposing a significant healthcare and economic burden. This study evaluates the health-seeking behaviour, healthcare utilization, and financial impact of major NCDs hypertension, diabetes, ischemic heart disease, and chronic kidney disease (CKD).MethodsA systematic search was conducted across global health databases, including PubMed, EMBASE, CINAHL, Scopus, Web of Science, ProQuest, and J-Gate. Simultaneously, searches were performed on Indian databases, journal websites, and Google Scholar for studies published between January 2014 and December 2024. A total of 1,462 studies were identified and exported to Rayyan software for screening. Two independent reviewers screened the studies based on predefined eligibility criteria. The quality of included studies was assessed using the Joanna Briggs Institute checklist, while data extraction was performed using Cochrane data collection forms. Meta-analysis was not conducted due to heterogeneity in the included studies. This review adheres to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.ResultsA total of 44 observational survey-based studies were included in this review. Financial constraints, geographical barriers, and awareness gaps influenced healthcare utilization for NCDs. While 60.5% relied on government services for affordability, 39.4% preferred private care for faster access. Out-of-pocket expenses, particularly for hemodialysis and cardiac interventions, posed a major financial burden. Treatment adherence varied by 70.1% among diabetic patients but only 32.4% among hypertensive women. Stockouts of essential medications in public hospitals and high costs of branded drugs in private facilities further restricted access. Emergency care utilisation was high for ischemic heart disease, while CKD patients faced long-term financial strain due to dialysis and frequent hospitalisations. Despite an increase in telemedicine use during COVID-19, accessibility challenges persisted. Systemic inefficiencies, cultural beliefs, and transportation issues further delayed timely care.ConclusionThis review highlights critical gaps in NCD care in India, particularly in treatment adherence, financial accessibility, and healthcare infrastructure. Strengthening public healthcare services, expanding insurance coverage for long-term NCD management, and integrating community-based interventions are key policy directions. Additionally, targeted strategies to improve health literacy and promote early disease detection are essential to improving health outcomes and reducing inequities in NCD care in India.Trial registrationPROSPERO registration number CRD42024576994.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12913-025-13441-x.

IntroductionLaser-assisted enamel conditioning combined with acid etching has shown potential in enhancing micromechanical retention. However, most prior studies were conducted under ideal dry conditions, overlooking the impact of saliva contamination, a common clinical challenge during sealant placement.ObjectiveThis study aimed to evaluate the effect of erbium-doped yttrium aluminium garnet (Er:YAG) laser pre-conditioning and saliva contamination on the shear bond strength (SBS) of a hydrophilic fissure sealant, UltraSeal XT® hydro™.MethodsForty extracted human mandibular molars were randomly divided into four groups (n = 10). Group 1 received acid etching only, Group 2 underwent acid etching followed by saliva contamination, Group 3 was treated with Er:YAG laser followed by acid etching, and Group 4 received Er:YAG laser, acid etching, and subsequent saliva contamination.The sealant was applied following treatment, after which all samples underwent thermocycling. SBS was tested using a universal testing machine, and the results were analyzed using descriptive statistics, one-way ANOVA, and Tukey’s post hoc test.ResultsGroup 3 demonstrated the highest SBS (mean: 22.3 MPa), significantly outperforming the other groups (p < 0.001). Group 2 exhibited the lowest SBS (mean: 19.6 MPa). Group 4 showed improved SBS compared to Group 2, suggesting partial mitigation of moisture effects by laser pre-conditioning.ConclusionWithin the limitations of this in vitro study, Er:YAG laser pre-conditioning significantly enhances the SBS of hydrophilic sealants, particularly under saliva-contaminated conditions, offering a promising strategy for improving sealant retention in clinically challenging scenarios.

Background: Diphtheria is an acute, fatal, bacterial toxin-induced disease and a significant health problem in developing countries. It remains endemic in India, including the state of Rajasthan.Materials and methods: The present study was a cross-sectional observational study conducted in a tertiary care center of Western India (Jodhpur, Rajasthan) over a period of one year (January to December 2019). All patients in the pediatric age group (up to 18 years of age) who presented with clinical features of suspected diphtheria per the WHO case definition and a positive throat swab for Klebs-Löffler bacillus (KLB) stain were enrolled in the study.Results: A total of 21,146 patients in the pediatric age group were admitted during the study period, out of which 66 fulfilled the inclusion criteria. The proportion of diphtheria was 3.121 per 1,000 admissions, with the highest number of cases admitted in the winter season from November to February 2019 (42, 63.64%). The male-to-female ratio was 1.87:1, and most cases were from lower socioeconomic strata (43, 65.15%), resided in rural areas (57, 86.36%), were partially immunized (42, 63.64%), and belonged to the 6-14 years age group (49, 74.24%). Most cases presented with pseudomembrane (64, 96.97%), followed by fever (60, 90.91%), dysphagia (57, 86.36%), and neck oedema (51, 77.27%). The most common complications were myocarditis (23, 34.85%), followed by polyneuropathy (17, 25.76%), acute kidney injury (16, 24.24%), bleeding diathesis (15, 22.73%), and multiple organ dysfunction syndrome (MODS) (11, 16.67%). Thrombocytopenia, high levels of blood urea, serum sodium and potassium, and creatine kinase-myocardial band (CK-MB) were significantly associated with poor outcomes, and 23 cases (34.84%) had abnormal ECG findings suggestive of myocarditis. The case fatality rate (CFR) was 18.18% (12/66), ranging from 11.90% among partially immunized cases to 33.33% among unimmunized children.Conclusion: High immunization coverage for diphtheria among children under five years of age has shifted the age group to 6-14-year-old children who are less immune to the disease. Biochemical parameters such as low platelets, high blood urea, serum sodium and potassium, and raised serum CK-MB are associated with poor outcomes. Myocarditis also carries a poor prognosis.

IntroductionKnowledge of obstetric danger signs among pregnant women can facilitate the timely recognition of obstetric danger signs, thereby leading to a reduction in overall maternal morbidity and mortality. Our cross-sectional study assessed the level of awareness among pregnant women about these obstetric danger signs and understood the influence of sociodemographic factors and obstetric history on their knowledge.MethodsThe study enrolled 165 participants who were pregnant women attending the antenatal outpatient department of a tertiary care hospital in Telangana. The participants, who gave consent for the study, were followed over two months and were surveyed using a semi-structured, interviewer-based questionnaire. This not only evaluated their awareness about obstetric danger signs but also included questions on their sociodemographic and obstetric profile. Their knowledge was graded in terms of a score of 0-10 based on the questions asked. Data were further analyzed using Microsoft Excel (Microsoft Corp., Redmond, WA, US) and GraphPad Prism Software version 5 (Insight Venture Management, LLC, New York, NY, US).ResultsAll the study participants (165) gave consent for the survey. Our study concluded that about 64.84% (107 out of 165) of the pregnant women had adequate knowledge about obstetric danger signs. In addition to this, there was a statistically significant (p < 0.05) association noted between adequate knowledge and occupation as a homemaker (53.37%, 57 out of 107), having their second pregnancy (36.44%, 39 out of 107), and a history of zero miscarriages (58.87%, 63 out of 107).ConclusionsThe study concluded that more than half of the participants had adequate knowledge, which could contribute significantly to improved maternal outcomes. The findings also highlight the various factors associated with awareness that can help tailor healthcare initiatives and policies in the long term.