Indian Medical Association

The presence of foreign bodies within the liver is an exceedingly rare event, typically resulting from either direct penetrating trauma to the abdomen or migration from the gastrointestinal tract. This report presents a case of a 21-year-old male, carpenter by occupation, who experienced accidental penetrating thoraco-abdominal trauma, leading to the retention of a metallic nail within the liver. The diagnosis was established based on conventional X-ray and CT scan findings; the nail was successfully retrieved via laparoscopy. This case underscores the significance of prompt diagnosis and intervention, which contribute to a favorable prognosis and improved outcomes in such injuries. Intrahepatic foreign bodies can lead to numerous complications, including hepatic abscess or hemorrhage, and may have life-threatening consequences, potentially resulting in mortality.

The Kochi Declaration 2024 (resulting from the International Leadership Summit of Medical Associations) marks a significant step in global TB elimination efforts. By emphasising private sector engagement, it addresses critical gaps in TB care delivery, particularly in high-burden countries where 60%–80% of patients initially seek care from private providers. This initiative aligns with the WHO’s public–private mix approach, enhancing case detection, treatment quality, and global health equity. It underscores the potential of collaborative strategies to accelerate progress towards a TB-free world by 2030, aligning with United Nations High-Level Meeting targets and broader global health goals.

Introduction: Dental plaque and gingivitis are prevalent concerns in pediatric populations. This multicentric randomized controlled trial aimed to compare the anti-plaque and anti-gingivitis efficacy of two fluoridated toothpastes, one experimental (Dentoshine) and one commercially available tooth paste among children aged 6–12 years. Materials and Methods: A total of 300 participants were randomly assigned in a 1:1 ratio to either the experimental or control group. Clinical parameters, including plaque index (PI) and gingival index (GI), were recorded at baseline, first follow-up, second follow-up, and third follow-up. Data were analyzed using independent t -tests, repeated measures analysis of variance (ANOVA), and Bonferroni post hoc tests. Results: Participant distribution was comparable across genders and age groups. Both toothpaste formulations showed significant reductions in plaque and gingival scores over time. In the experimental group, repeated measures ANOVA showed a significant decrease in PI scores ( F = 53.695, P = 0.001), with the most substantial reduction between baseline and the third follow-up (mean difference = 0.874, P < 0.001). Similarly, the control group showed significant plaque reduction ( F = 55.82, P = 0.000). GI scores also improved significantly in both groups, with the Dentoshine toothpaste showing a greater decline ( F = 81.431, P < 0.001). Post hoc analysis confirmed that improvements were statistically significant from the second follow-up onward. Conclusion: Both fluoridated toothpaste formulations were effective in reducing plaque and gingivitis with regular use. However, the Dentoshine toothpaste demonstrated slightly superior performance in long-term plaque and gingival health outcomes among children.

Pharmacological management of osteoarthritis: Position statement of the Indian Orthopaedic Rheumatology Association - Osteoarthritis (OA) is the most common form of arthritis in the general population, accounting for more pain and functional disability than any other musculoskeletal disease. There remains a paucity of effective and safe pharmacologic options for the management of OA, with oral and topical nonsteroidal anti-inflammatory drugs (NSAIDs) being the primary medications recommended. Therefore, nutraceuticals and supplements have emerged as possible adjuncts or alternatives. Undenatured collagen type II has been studied for its potential benefits during OA supportive care in preclinical and clinical studies, demonstrating positive results with substantially lower therapeutic doses. This review article aims to provide a scientific rationale for a treatment algorithm for the management of OA, including analgesics and nutraceuticals such as undenatured collagen type II and other nutrients. Keywords: Osteoarthritis, Oral analgesia, Non-surgical management, Topical medication, Intra-articular delivery, Nutraceuticals, Undenatured type II collagen

Objective:This cross-sectional study investigates the prevalence and clinical outcomes of upper gastrointestinal bleeding (UGIB) among patients at a tertiary care center. It focuses on esophageal varices and their association with hepatitis C and B infections.Methods:A total of 383 patients aged 18 and above who presented with UGIB were included. Data were collected from the hospital’s endoscopy department and analyzed using Statistical Package for the Social Sciences (SPSS) version 25 and R package. Key variables included age, gender, endoscopic findings, and the presence of esophageal varices. Fisher’s exact test was used to evaluate the association between hepatitis infections and variceal bleeding. The statistical significance cut-off was P <0.05.Results:The mean age of the 383 patients was 56 ± 11 years, with a male predominance (55.4%). Esophageal varices were the most common finding (78.3%) and were strongly associated with hepatitis C (P < 0.001), with 70.7% of hepatitis C patients presenting with varices. Hepatitis B had a much weaker association, with only 1.7% of patients with varices also testing positive for hepatitis B. Acid peptic disease, present in 11% of cases, was more common in females. The statistical analysis confirmed a significant relationship between hepatitis C and esophageal varices. The study highlights the need for routine variceal screening and hepatitis C management in high-risk populations.Conclusion:Esophageal varices are the leading cause of UGIB in this population, particularly in patients with chronic hepatitis C. The findings underscore the importance of early intervention and management of hepatitis C to reduce the incidence and mortality associated with variceal bleeding in chronic liver disease patients.

Shellfish harvesting holds cultural significance for Alaska Native coastal communities, yet consuming untested shellfish poses serious health risks, with Alaska Natives facing disproportionately higher exposure to shellfish toxins. Traditional knowledge has historically informed risk mitigation, but climate change is altering exposure patterns, diminishing the predictability of exposures and challenging the reliability of traditional practices. In response, the Southeast Alaska Tribal Ocean Research (SEATOR) network—a tribally led initiative—maintains a near real-time toxin data website, while the Sitka Tribe of Alaska has developed culturally grounded environmental education programming to enhance toxin risk awareness and support safe harvesting practices. This study assesses the impact of a middle school program aimed at increasing awareness of toxin risks, promoting safe harvesting, and encouraging the use of the SEATOR website to check toxin levels. Using the Theory of Planned Behavior (TPB), we evaluated shifts in children’s beliefs and behavioral intentions regarding shellfish harvesting and toxin exposure risk mitigation. Participants included 50 middle school students across three communities in Southeast Alaska—Sitka, Hoonah, and Juneau. Research activities included pre- and post-program surveys and interviews and a one-year follow-up survey. Using the survey data, we used generalized estimating equation linear regression to investigate pre-post program changes in TPB beliefs and behavioral intentions related to shellfish harvesting and consumption and a specific risk reduction strategy: checking the SEATOR website for toxin levels. We also assessed how changes in TPB beliefs relate to changes in harvesting and risk reduction behavioral intentions. Interviews were intended to contextualize the changes in beliefs and behavioral intentions measured in surveys. Results indicated pre-post program shifts. Overall, participants reported more positive perceptions and increased behavioral intentions towards shellfish harvesting and checking the SEATOR website, but differences emerged across sites and reported race. Participants’ understanding of the risk reduction strategy and confidence in their ability to check the SEATOR website increased and suggests that encouraging the use of an accessible risk reduction strategy is effective in promoting the adoption of safe environmental and health behaviors. Participants also indicated that family involvement in harvesting shaped perceptions, underscoring the need for family engagement in youth environmental education. Our findings emphasize that culturally tailored environmental education that integrates risk perception and practical risk reduction strategies within local ecological and cultural contexts can influence children’s safe harvesting intentions. This work suggests the broader applicability of culturally informed ocean literacy programs in promoting public health and environmental stewardship.

Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder of growing global health concern characterized by insulin resistance and elevated blood sugar levels. While conventional medications offer significant benefits, they often come with adverse effects such as gastrointestinal disturbances and weight gain. Ayurveda, an ancient Indian system of medicine, provides a holistic alternative through the use of herbal and herbo-mineral formulations. Ayurveda and Yoga have emerged as complementary therapies with promising potential in diabetes management. This review discusses Ayurvedic formulations like Ayush- 82, PANHEAL, Dhanwantaram Kashayam, Shilajatvadi Lauha, and other standardized polyherbal therapies highlighting their efficacy in reducing blood sugar levels, improving insulin sensitivity, have demonstrated significant antioxidant, and lipid-lowering effects, as shown in various preclinical and clinical studies addressing complications related to T2DM. Also, this review explores the effectiveness of Ayurvedic formulations like GlucoCare and holistic modules that combine Panchakarma and Yoga practices. Clinical trials and studies demonstrate that these Ayurvedic interventions offer promising results in managing diabetes without the side effects associated with modern medications. Integrating these traditional therapies with modern treatments may offer a more holistic approach to managing diabetes.

Background For more than 150 years, dental amalgam (DA) has been popular as a dental restorative material. Many organizations oppose its use due to perceived toxicity and environmental concerns. Hence, this study aimed to explore the continued use of DA from a South Indian dental practitioners’ perspective. Methods This cross-sectional study was conducted among fifty-two private and public dental practitioners of Udupi district in Southern India. A self‑administered questionnaire was distributed, that involved assessment of their preferences, continuation of use and concerns of using DA as a restorative material. The percentage contribution of each variable was calculated. Preferences for continuation of use of silver amalgam based upon the age, experience and mercury toxicity as a risk factor were analyzed using Students-t test and Chi-square test. Results Most dentists were satisfied (87%) with the results of the DA, found minimal failures (96%) and found DA more economical (89%). More than half (54%) of the participants reported that they would not continue the use of DA owing to mercury toxicity and environmental concerns. Dentists with higher age and longer clinical experience preferred continuation of DA. Conclusions Despite satisfaction with DA for its minimal failure, longevity and affordability, the authors found that most practitioners did not prefer its continued usage. This highlights their concerns over mercury toxicity and soft tissue lesions and accentuates their community social responsibility. There is also an urgent need to educate dentists on mercury hygiene, mercury waste management and disposal.