Kasturba Medical College Hospital

Background/Objectives: Speech understanding in noise relies on both temporal fine structure (TFS) and temporal envelope (ENV) cues. While TFS primarily conveys interaural time differences (ITDs) at low frequencies, ENV cues can also support ITD processing, especially when TFS is unavailable or degraded. Expanding the ENV by increasing modulation depth has been proposed to improve speech perception, but its effects on spatial release from masking (SRM) and binaural temporal processing in normal-hearing listeners remain unclear. The goal of this study was to evaluate the effect of ENV enhancement on SRM in young adults with normal hearing and its influence on ITD sensitivity and interaural coherence (IC). Method: Thirty normal-hearing native Kannada speakers (19-34 years) participated. Speech stimuli consisted of Kannada sentences embedded in four-talker babble at -5, 0, and +5 dB signal to noise ratio (SNR). Target and masker were spatialized using head-related transfer functions at 0°, 15°, and 37.5° azimuths. Stimuli were presented with and without ENV enhancement (compression-expansion algorithm). Speech recognition scores were analyzed using generalized linear mixed models, and SRM was calculated as performance differences between co-located and spatially separated conditions. Cross-correlation analyses were performed to estimate ITDs and IC across SNRs. Result: ENV enhancement yielded significantly higher SRM values across all SNRs and spatial separations. Benefits were greatest at lower SNRs and wider target-masker separations. Cross-correlation analysis showed enhanced IC and more reliable ITD estimates under the expanded condition, particularly at moderate SNRs. Conclusions: Temporal ENV enhancement strengthens spatial unmasking and binaural timing cues in normal-hearing adults, especially under adverse listening conditions. These findings highlight its potential application in auditory rehabilitation and hearing technologies where ENV cues are critical.

Dumb-bell shaped lipomas of the sole are exceedingly rare due to the paucity of adipose tissue in this region. We report a case of a 60-year-old male who presented with a painless, progressively enlarging swelling on the plantar aspect of the left foot, which subsequently developed a pressure ulcer over the same area. Magnetic resonance imaging (MRI) revealed a well-defined, dumb-bell shaped lipomatous lesion traversing the plantar fascia. The patient underwent a wide local excision, and histopathological analysis confirmed the diagnosis of a lipoma. Postoperative recovery was uneventful, with no recurrence at 6-month follow-up. This case underscores the importance of considering deep-seated dumb-bell lipomas in atypical plantar swellings and highlights the crucial role of MRI in preoperative planning to ensure complete excision and prevent recurrence.

Objectives: To study the clinical profile of UTI, its recurrence, and effect of glycemic control on recurrence in patients with diabetes mellitus (DM). Methods: A cross-sectional study was conducted on 200 patients with DM, with urine culture-positive results having symptomatic or asymptomatic bacteriuria. Patient details in terms of clinical profile, microbiological patterns, and treatment modalities were recorded and statistically analyzed. Results: The mean age of the patients was 63.4 ± 12.3 years, with 49% males. The mean duration of diabetes was 7.97 ± 7.02 years. Urine culture showed that 128 (64%) cases had E. coli , 40 (20%) cases had Klebsiella pneumoniae , 12 (6%) cases had Enterococcus faecalis , nine (4.50%) cases had Pseudomonas aeruginosa , three (1.50%) cases had Citrobacter koseri , two (1%) cases had Candida tropicalis , and one (0.50%) case each had Enterobacter aerogenes, Enterobacter cloacae, Pantoea spp., Proteus mirabilis, Serratia marcescens , and Streptococcus . Recurrent UTI was observed in 12% of cases. HbA1c levels did not significantly affect UTI recurrence across different age groups and genders. Conclusion: E. coli was the most commonly isolated pathogen (64%), followed by Klebsiella pneumoniae (20%). Recurrence of UTIs was seen in 12% cases, and it was not significantly associated HbA1c levels, indicating that glycemic control did not significantly affect the recurrence rate.

Weber type B ankle fractures present a common surgical challenge, with the optimal fixation approach remaining debated. This retrospective study compared clinical and radiological outcomes of posterior versus lateral fixation using locking one-third tubular plates in 118 patients. Posterior fixation demonstrated superior biomechanical stability and fewer hardware-related complaints, whereas lateral fixation offered shorter operative duration. At six months, patients in the posterior fixation group achieved better functional recovery and experienced fewer soft tissue complications. These findings support posterior plating as an effective alternative to the conventional lateral approach in suitable cases.

Background Obesity is a major consequence of malnutrition and significantly contributes to the global burden of chronic diseases. Currently, there are more overweight and obese individuals than underweight individuals. Increased fiber intake can increase insulin sensitivity and fat oxidation. According to research studies, the average dietary fiber consumption is below the recommended value, and the WHO anticipates that the worldwide obesity prevalence has increased in the past ten years. Aim To evaluate the effect of high dietary fiber intake on insulin resistance, body composition, and weight in overweight and obese middle-aged women. Method This hospital-based study evaluated 500 people during phase 1 to identify the prevalence of insulin resistance among overweight and obese middle-aged women. An RCT with intervention and control arms for 180 individuals is being conducted in Phase 2 to determine the effect of increased dietary fiber consumption on insulin resistance, body composition, and weight in overweight or obese middle-aged women. In the intervention group, women were counselled for 15 min and given a tailored food chart including 40 g of fiber. Women in the control arm will receive a typical food care plan with 25 g of fiber, based on their health status. Each engaged woman received fiber nutritional empowerment. Discussion Increasing dietary fiber consumption can improve insulin resistance, body composition, and weight in middle-aged overweight and obese women. Trial registration The Clinical Trials Registry of India (CTRI/2022/01/039074) has registered this study as a clinical trial on January 3, 2022 http://ctri.nic.in

Objectives Traumatic Brain Injury (TBI) is a leading cause of morbidity, mortality, especially in India. Knowledge of the epidemiological profile of TBI can be useful in planning preventive and corrective measures to improve outcomes. However, in India, the data on TBI is often incomplete due to the absence of well-preserved registries and documentation. Through this paper, we hope to present a better understanding of TBI, presentation, and implications that may promote reforms. Material and Methods This retrospective observational five-year study assesses data from an in-hospital trauma registry of TBI. Data included patients’ demographic profiles, type of injury, radiological findings, examination, management details, and outcome during current hospitalisation. Using this data collected, we hope to understand and analyse the profile of patients who present with TBI. Results The cohort included 1934 TBI patients with male preponderance (79.79%), mainly in the 20–40-year age group, with road traffic accidents (RTA) being the most common cause, more so in two-wheelers and pedestrians, followed by fall from height. Associated orofacial injuries (28.8%), spinal trauma (11.11%), and polytrauma (13.4%) were noted. Based on the Glasgow Coma Scale (GCS), 57% had mild TBI. From the ones with moderate-severe TBI, 57.5% underwent surgery. The severe TBI group showed 22% mortality. Our data reflects the TBI profile from the semi-urban population in South coastal India. Males in the younger age group driving two-wheelers are the most susceptible group. Despite being low-velocity accidents, nearly one-third of the cases required emergency surgery, and nearly one-fifth succumbed to the injury. Conclusion Our study marks a first-of-its-kind registry from a south Indian centre, highlighting the importance of maintaining a complete trauma-based electronic registry. We hope that data from this study can help understand the natural history of TBI and aid the formulation of policies right from the onset - pre-hospital care to definitive management to prevent disabilities.

Nutraceuticals like methyl gallate and chia seed oil are gaining global attention for their therapeutic potential. This study investigates their effects on hepatocyte apoptosis and liver architecture in a doxorubicin-induced hepatotoxicity model, utilizing techniques such as TUNEL assay, immunohistochemistry (Bax & Bcl2), H&E staining, and scanning electron microscopy. Thirty female Wistar rats were divided into five groups (n=6): Group I (Normal healthy control), Group II (Doxorubicin-intoxicated control), Group III (Doxorubicin-intoxicated + methyl gallate), Group IV (Doxorubicin-intoxicated + chia seed oil), and Group V (Doxorubicin-intoxicated + both). Liver function tests, histology, and cell apoptosis analysis were performed to assess the effects. Doxorubicin-intoxicated rats (Group II) exhibited significantly elevated ALT, AST, and ALP levels (p < 0.001) and severe hepatic damage compared to controls. Group III and Group IV showed significant reductions in liver enzyme levels (p < 0.05 and p < 0.01, respectively), while Group V demonstrated the most significant decrease (p < 0.001). Immunohistochemistry revealed increased Bax and decreased Bcl2 expression in Group II (p < 0.001), which improved significantly with methyl gallate, chia seed oil, and their combination (p < 0.05 to p < 0.001). TUNEL assay showed reduced apoptotic index in treatment groups, with Group V showing the most significant reduction (p < 0.001). Scanning electron microscope (SEM) analysis confirmed restoration of hepatocyte architecture, especially in Group V. Methyl gallate and chia seed oil, individually and in combination, demonstrated significant hepatoprotective effects against doxorubicin-induced hepatotoxicity, with the combination showing the greatest efficacy. These nutraceuticals hold promise as adjunct therapies to reduce doxorubicin-induced liver injury.

Paracetamol is considered to be a safe and effective drug and is available over the counter in many countries including Nepal. Though it is considered safe at its therapeutic dose, it may be toxic at higher dose. It is recognized as a major drug leading to poisoning in the United States of America,United Kingdom and even in Nepal. Several factors such as age of the patients, sex, alcohol intake, disease conditions, concomitant drug intake etc are known to be important factors affecting the severity and outcome of the poisoning. The signs and symptoms are exhibited in a sequentialmanner and may start with mild nausea and may end with fulminant hepatic failure. Though paracetamolpoisoning is associated with many complications and may affect the cardiovascular, respiratory and renal systems, hepatotoxicity is the major complication leading to death. Since paracetamol may beavailable in combination with other drugs, on many occasions the patient may not present with classical symptoms of paracetamol poisoning. Several laboratory investigations along with the patients’ signs and symptoms help in diagnosis. The management involves symptomatic treatmentand a specific antidote mainly N-acetyl cysteine. The estimation of plasma paracetamol concentrationis beneficial in diagnosing as well as monitoring the poisoned patient. The pattern and management of paracetamol poisoning varies with the patient populations such as pregnant women, pediatricpatients etc. Several strategies including restriction of pack size have been implemented worldwide to prevent the occurrence of paracetamol poisoning. Availability of unbiased drug information isvery much essential in management.

Tuberculosis (TB) and diabetes mellitus (DM) co-morbidity is one of the rising public health problems. There is growing evidence that DM is an important risk factor for TB. This study was carried out to know the prevalence of DM among newly detected sputum positive pulmonary TB patients registered in District Tuberculosis Centre and to assess the risk factors of DM among TB patients. In a cross-sectional study, newly detected sputum positive pulmonary TB patients were screened for DM (those having symptoms of DM). Furthermore, they were diagnosed by detecting blood glucose levels (≥200 mg/dL). Mean, standard deviation (SD), Chi-squared and Fisher-Freeman-Halton exact tests were used to determine the significant associations. P-values less than 0.05 were considered to be statistically significant. A total of 215 TB patients were included in this study. The prevalence of DM among TB patients was found to be 23.7% (2.8% known and 97.8% new cases). Significant associations were found between age (>46 years old), educational status, smoking habits, alcohol consumption, physical activity, presence of DM symptoms and family history of DM. Routine screening for DM is mandatory due to its increasing prevalence, which may help in early diagnosis and to reduce complications by proper management that in turn helps in the successful outcome of TB treatment.