Indira Gandhi Institute of Medical Sciences

Acute and chronic postoperative low back pain are frequent occurrences after lumbar spine surgery, contributing to long-term disability and increased analgesic use. Neuromodulation techniques-both invasive and non-invasive-have emerged as promising non-pharmacological interventions. However, current evidence remains fragmented. This systematic review and meta-analysis aimed to evaluate the effectiveness and safety of neuromodulation in managing acute and chronic postoperative low back pain. We systematically searched PubMed, Scopus, and Cochrane databases from inception up to 30 June 2025 for randomized controlled trials (RCTs) published in English only comparing neuromodulation to sham modulation in patients with postoperative low back pain following lumbar spine surgery. The review protocol was registered in PROSPERO (CRD420251108776). Primary outcomes included pain intensity reduction, analgesic consumption, functional disability, and adverse effects. Standardized mean differences (SMDs) with 95% confidence intervals (CIs) for continuous outcomes were calculated using a frequentist random-effects model. Proportions and 95% CIs for binary outcomes, including adverse events and sex distribution, were computed using the Freeman-Tukey double arcsine transformation to stabilize variance. Heterogeneity was assessed using the I2 statistic and Cochrane's Q test. Twelve RCTs involving 413 patients (mean age 53years; 55% female) were included, with 207 (50%) receiving neuromodulation. In the pooled analysis, neuromodulation significantly reduced pain intensity (SMD-0.82; 95% CI [-1.13, -0.50]; p<0.00001; I2=53%) and analgesic consumption (SMD-0.91; 95% CI [-1.63, -0.20]; p=0.01; I2=81%) compared to sham. No significant difference was found in functional disability (SMD-0.31; 95% CI [-0.85, 0.24]; p=0.28; I2=44%). The pooled female proportion was 55% (95% CI [42.99, 66.95]; I2=73%), and the prevalence of adverse effects was 12.48% (95% CI [6.13, 20.39]; I2=0%). This meta-analysis demonstrates that neuromodulation significantly reduces postoperative pain and opioid consumption after lumbar spine surgery, although it does not improve functional disability. Given the growing need for non-pharmacological pain management strategies, neuromodulation represents a promising evidence-based adjunct in postoperative care. Future high-quality RCTs should refine optimal protocols and evaluate long-term functional outcomes.

Schwannomas are rare, benign, and slow-growing tumors that originate from the Schwann cells of peripheral nerves. They exhibit no sex predilection and are often characterized by a variable and delayed clinical presentation. The definitive diagnosis is established through histopathological examination. In this report, we present a rare case of a schwannoma arising from the lateral wall of the nasal cavity in a 45-year-old male patient. The tumor was successfully excised via endoscopic nasal surgery, and there was no recurrence observed at six-month follow-up.

Background Chronic kidney disease (CKD) is a progressive renal disorder strongly associated with oxidative stress, which contributes to renal damage and systemic complications. Oxidative stress results from an imbalance between the production of reactive oxygen species (ROS) and antioxidant defence mechanisms. This study aimed to evaluate oxidant and antioxidant levels across different stages of CKD. Methods This cross-sectional comparative study was conducted on 180 subjects, including 90 CKD patients and 90 healthy controls. CKD patients were classified into Stage III, Stage IV, and Stage V. Serum malondialdehyde (MDA) and superoxide dismutase (SOD) were measured to assess oxidative stress using standard laboratory assays. Data were analysed using one-way ANOVA with Brown-Forsythe adjustment, and a p-value <0.05 was considered statistically significant. Results A progressive increase in serum MDA and a significant decrease in SOD levels were observed across CKD stages compared with controls. Stage V patients demonstrated the highest MDA concentrations and the lowest SOD activity, indicating severe oxidative imbalance. Differences between groups were statistically significant (p < 0.001). Additionally, serum creatinine levels showed a consistent rising trend with advancing CKD severity. Conclusion The study findings indicate a shift toward oxidant dominance as CKD progresses, characterised by enhanced lipid peroxidation and reduced antioxidant enzyme activity. These biochemical alterations highlight the importance of oxidative stress monitoring in CKD and suggest the potential benefit of antioxidant-targeted therapeutic strategies. Further longitudinal and interventional research is necessary to explore the clinical impact of oxidative stress reduction on CKD outcomes.

To investigate the spatial gradient of intraoperative impedance across the cochlear electrode array in pediatric cochlear implant recipients and assess its potential as a physiological indicator for the electrode-neural interface. A prospective observational study involving 56 pediatric patients underwent cochlear implantation with Cochlear Nucleus devices. Intraoperative polarized impedance and electrically evoked compound action potential (ECAP) threshold were recorded across all 1232 electrodes using AutoNRT software. Eight electrodes with open- or short-circuit were excluded, leaving 1,224 for analysis. Impedance values were categorized by cochlear region (basal, middle, apical), and electrodes with elevated impedance (10-20 kΩ) were analyzed for regional distribution and clinical relevance. Data were analyzed for spatial patterns and correlation with the ECAP threshold profiles. A consistent basal-to-apical increase in impedance was observed (7.7 ± 1.9, 9.2 ± 1.4, 10.8 ± 1.5 kΩ; p<0.001). Impedance and ECAP threshold were weakly correlated (ρ = -0.20, p<0.001; β = -1.26, p<0.001), with a positive association in the apical region (ρ = 0.12, p = 0.048). Electrodes with higher impedance (10-20 kΩ) were less likely to show elevated or absent TNRT (OR = 0.175, p = 0.02). The impedance gradient persisted across age groups and was significantly correlated with ECAP threshold patterns. Intraoperative impedance monitoring reveals a strong and physiologically consistent gradient, with higher values in apical electrodes. This gradient reflects anatomical and tissue interface variations, which may offer a valuable physiological indicator for intraoperative electrode positioning and neural interface integrity.

Introduction:Tenosynovial giant cell tumor (TSGCT), formerly known as pigmented villonodular synovitis, is a rare, benign, locally aggressive neoplasm originating from the tendon, bursa, or synovium. It is broadly categorized into localized TSGCT (L-TSGCT) and diffuse TSGCT types, with the localized form more commonly affecting the tendon sheaths of the hand and fingers. This report describes a rare presentation of a L-TSGCT involving the flexor tendon sheath of the right thumb in a 40-year-old male, managed successfully with complete excision.Case Report:We report a case of a 40-year-old male who presented with a 1-year-old history of a slowly growing, painless mass over the right thumb, along with restriction of movement. Clinical examination revealed a firm, non-tender, mobile mass measuring approximately 3 cm × 3 cm. X-ray revealed a soft-tissue shadow with pressure scalloping and erosion over the distal phalanx of the right thumb. Magnetic resonance imaging (MRI) demonstrated a well-defined lobulated T1 and T2 isointense lesion with erosion of the distal phalanx of the thumb. The patient underwent complete marginal surgical excision along with the use of local adjuvant chemical cauterization of the bony erosion bed with 88% phenol for 1 min to prevent recurrence. Intraoperatively, it was a well-encapsulated, yellowish-brown nodular mass adherent to the flexor sheath without infiltration into the neurovascular bundle. The post-operative course was uneventful, and the patient achieved a full range of motion at 4 months of follow-up.Conclusion:L-TSGCT of the thumb is uncommon but should be considered in the differential diagnosis of soft-tissue swellings in the digits. MRI assists in delineating lesion extent and planning surgical excision. Histopathological analysis confirms the diagnosis of L-TSGCT. The tumor’s characteristic imaging profile and indolent clinical course highlight the need for accurate pre-operative diagnosis. Complete surgical excision, preferably preserving digital function, remains the gold standard, offering a high chance of cure. Use of adjuvants such as phenol might reduce the risk of recurrences, especially in cases of bony involvement. Long-term follow-up is strictly advisable.

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.

Background: Chronic myeloproliferative disorders (CMPDs), including Polycythemia Vera (PV), Essential Thrombocythemia (ET), and Primary Myelofibrosis (PMF), are clonal hematopoietic stem cell disorders characterized by dysregulated proliferation of myeloid lineages. Platelet abnormalities are central to their pathophysiology, predisposing patients to both thrombotic and hemorrhagic complications. Automated hematology analyzers provide platelet indices such as mean platelet volume (MPV), platelet distribution width (PDW), platelet-large cell ratio (P-LCR), and plateletcrit (PCT), that can serve as inexpensive biomarkers for diagnosis and prognostication. Methods: A prospective observational study was conducted in the Department of Hematology/Pathology, Indira Gandhi Institute of Medical Sciences (I.G.I.M.S., from April 2020 to June 2022. A total of 160 patients diagnosed with CMPDs according to the World Health Organization (WHO) 2016 criteria were enrolled. Demographic, clinical, and laboratory data were collected. Platelet indices were recorded using a fully automated hematology analyzer. Data were analyzed using ANOVA, t-tests, chi-square, and correlation analyses, with p &lt; 0.05 considered significant. Results: ET was the most common CMPD (45%), followed by PV (33.8%) and PMF (21.2%). ET patients exhibited significantly higher platelet counts compared to PV and PMF (p &lt; 0.001). PMF patients demonstrated the highest MPV, PDW, and P-LCR values, reflecting abnormal megakaryopoiesis. Thrombotic events occurred in 16.3% of patients and correlated with elevated MPV and PDW, while bleeding events (8.8%) were associated with increased PDW and reduced PCT. Conclusion: Platelet indices differ significantly among CMPD subtypes and were associated with vascular complications. They represent cost-effective, readily available markers that may complement molecular and histological investigations for diagnosis, risk stratification, and disease monitoring in CMPDs. Keywords: Chronic myeloproliferative disorders, platelet indices, thrombocytosis

Introduction: Childbirth poses significant physical and psychological challenges like increasing the risk of postpartum psychiatric disorders, including postpartum depression (PPD), anxiety and psychosis. Epidural analgesia (EA) is widely recognized for its efficacy in managing labor pain,its impact on maternal mental health and neonatal neurodevelopment remains uncertain. This meta-analysis evaluates the effects of EA on maternal psychiatric outcomes, including PPD, anxiety, mother-infant bonding, and autism spectrum disorder (ASD) in offspring. Methods: A systematic review of PubMed, Cochrane Library, and Scopus databases was conducted. Studies providing quantitative data on psychiatric outcomes, including odds ratios (ORs) were included. Data were analyzed using the DerSimonian and Laird random-effects model. Heterogeneity was assessed with Cochran’s Q and I² statistics, and publication bias was evaluated using funnel plots and Egger’s test. Sensitivity analyses ensured robustness. Results: This Meta-analysis included fifteen studies (n = 42,342 participants) which showed that using EA during labour reduced the risk of PPD (pooled OR: 0.56; I² = 42%) and Maternal Anxiety (pooled OR: 0.62; I² = 48%) and it also improved Mother-Infant Bonding (pooled OR: 1.45; I² = 38%). However, there was no significant association found between EA and ASD (pooled OR: 1.04; I² = 21%). Conclusion: Epidural analgesia offers notable benefits for maternal mental health, reducing PPD and anxiety while enhancing mother-infant bonding. These findings reinforce its value in labor management but highlight the need for further research on long-term effects and specific anesthetic agents.

Women with autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and others face a disproportionate burden of cardiovascular disease (CVD), in part due to inflammation-driven dyslipidemia. Unlike classical metabolic dyslipidemia, these lipid abnormalities are characterized by low high-density lipoprotein (HDL) cholesterol, elevated triglycerides, dysfunctional HDL, and increased oxidized low-density lipoprotein. The interplay of chronic inflammation, immune dysregulation, hormonal factors, and treatment-related effects contributes to a unique lipid phenotype that amplifies CVD risk in women. This narrative review explores the epidemiology, pathophysiology, and clinical manifestations of dyslipidemia in SLE and RA, with an extension to other autoimmune diseases such as psoriatic arthritis, Sjögren’s syndrome, systemic sclerosis, and autoimmune thyroid disorders. Management strategies, including early screening, inflammation control, statin therapy, and gender-specific considerations, are highlighted. The article underscores the urgent need for tailored risk assessment tools and therapeutic approaches to mitigate premature cardiovascular morbidity and mortality in this vulnerable population.

BackgroundStroke is a major cause of death and disability in India. Many stroke patients seek care at government medical colleges but studies have not comprehensively assessed the quality of acute stroke care. This study aims to evaluate key indicators for optimal stroke care in the pre- implementation phase of implementation of an evaluation and treatment package for uniform stroke care (IMPETUS) study across 23 medical colleges in India.MethodsIMPETUS stroke is a multicentric, prospective, multiphase, mixed-methods, quasi-experimental implementation study, comprising three phases. During its pre-implementation phase, baseline assessment of stroke care was performed using pre-structured case report form, among prospectively enrolled acute stroke patients.ResultsA total of 2,018 patients were enrolled during the pre-implementation phase. The mean (SD) age was 59.08 (14.4) years, with male preponderance (64.2%); 69.06% had an onset <24 h, majority had ischemic stroke (60.1%), followed by intracerebral hemorrhage (38.4%). Key risk factors were hypertension, diabetes, smoking, alcohol and previous stroke. Imaging performed included non-contrast computed tomography (NCCT) (69.6%), computed tomography angiography (CTA) (25.6%) and magnetic resonance angiography (MRA) (24.6%). Intravenous thrombolysis (IVT) was administered in 39.2% eligible patients, predominantly with tissue plasminogen activator (tPA) (72%). In-hospital delay was the most common reason for not receiving thrombolysis (44.8%). The median door-to-CT, CT-to-needle and door-to-needle time were 95, 36.5 and 67 min, respectively. Other important stroke care indices were also evaluated. In-hospital mortality was 19.4 and 33.1% patients achieved modified rankin scale (mRS) score 0–2 at 90-days.ConclusionThis comprehensive data provides a representative baseline status of acute stroke care in select medical colleges across India, which will be useful in comparing advancements during the implementation phase and improve policy making.