PSG Institute of Medical Sciences & Research

Abstract: Bioactivation and clearance of anticancer agents are crucial factors in the efficacy and toxicity of anticancer drugs. Exosomes are membrane-bound vesicles secreted by tumor cells and the tumor microenvironment. These vesicles contain drug-metabolizing enzymes, transporters, and RNA. Exosomes can be non-invasively collected from the blood. This article has been prepared by combining the evidence of the role of exosomal cytochrome P450 isoforms, such as cytochrome P450 family 2 subfamily C member 19, cytochrome P450 family 2 subfamily D member 6, and cytochrome P450 family 3 subfamily A member 5, in the oxi-dation of anticancer drugs in the first phase of drug metabolism. Exosomal UDP-glucuronosyl-transferase 1A1 has been found to help in the conjugation of anticancer drugs in the second phase of drug metabolism. Exosomal ATP-binding cassette transporters, P-glycoprotein, mul-tidrug resistance-associated protein 1, and breast cancer resistance protein have been found to act as intercellular conveyors of drug efflux capacity. These transporters can modulate the ef-ficacy of chemotherapy. Exosomal microRNAs, such as microRNA-21, microRNA-155, and microRNA-1246, have been found to modulate apoptosis, DNA repair, metabolic adaptation, and chemotherapy resistance through the PI3K/AKT pathway, EZH2/STAT3 pathway, and PDCD4 pathway. Long non-coding RNAs, such as UCA1 and HOXA antisense RNA, can reprogram the chromatin structure. These long non-coding RNAs can suppress tumor suppres-sor genes, thus leading to chemotherapy resistance. Bioinformatics pipelines have been de-signed to bridge the gap between exosomal RNA and protein levels in the profile of dynamic metabolic states. The challenges in the field of exosomal therapy drug monitoring have been discussed in the article. The article has recommended the use of artificial intelligence in the integration of omics with microfluidic technology for the improvement of exosomal therapy drug monitoring.

BackgroundMeningiomas exhibit substantial biological and clinical heterogeneity, and traditional histopathology alone often fails to accurately predict tumor behavior. Advances in molecular and genetic profiling have significantly enhanced diagnostic precision, prognostic assessment, and therapeutic decision-making.MethodsThis review synthesizes current evidence on genomic, epigenomic, transcriptomic, and liquid biopsy–based approaches used to characterize meningiomas.ResultsKey developments include characterization of NF2 and non-NF2 driver mutations, refinement of DNA methylation-based classification systems, identification of high-risk markers such as TERT promoter mutations and CDKN2A/B deletions, and the emergence of targeted therapeutic strategies. Liquid biopsy and circulating biomarkers further enable non-invasive disease monitoring and molecular risk stratification.ConclusionMolecular profiling has transformed meningioma classification and risk prediction, supporting a shift toward precision neuro-oncology. Future progress will depend on integrated multi-omic diagnostics, improved biomarker-guided surveillance, and development of targeted therapeutic options for aggressive molecular subgroups.

Background Osteoarthritis (OA) is the most common form of arthritis affecting the elderly and obese population, and requires long-term medical management. Inflammatory pathways, possibly initiated by tissue damage and stress are involved in the pathogenesis of OA. Citrus medica Linn., known for its anti-inflammatory and analgesic properties, has been the focus of management of OA in recent years. Purpose To explore the therapeutic potential of Citrus medica gel in Wistar Albino rat OA model with standard Aceclofenac gel. Materials and Methods An experimental interventional animal study was conducted in which OA was induced in 24 male Wistar Albino rats (12-week-old) using monosodium iodoacetate. The animals were observed for 1 week for signs of joint inflammation. They were then divided into four groups. Group A (standard) received Aceclofenac gel twice daily (BD) for 4 weeks. Group B received C. medica gel (0.2 g, 0.33% w/w) once daily (OD). Group C received C. medica gel (0.2 g, 0.33% w/w) BD, and Group D was kept as a disease control throughout the study. The results were compared between groups using one-way analysis of variance (ANOVA). Results The double-dose C. medica gel regimen displayed a significant and earlier reduction in ankle joint circumference (ANOVA, p value < .001). Pain relief was observed, as evidenced by a favorable reversal of the arthritic index and score compared to the standard treatment. Conclusion This study highlights the potential of C. medica gel in reducing inflammation and pain associated with OA. These findings warrant further investigation through clinical trials.

Background Cardiovascular health remains susceptible to inaccurate information, which can harm health outcomes. This scoping review addresses a gap in comprehensive analyses by synthesising evidence on the prevalence, spread, impact and correction strategies related to cardiovascular health misinformation across diverse populations and settings. Methods Following Joanna Briggs Institute guidelines, we searched MEDLINE, EMBASE, Global Index Medicus, Web of Science. A dual-reviewer process, using Covidence, screened articles in two phases (title/abstract, full-text) based on predefined inclusion criteria. Data extraction was performed by two reviewers, and results were synthesised narratively, presented by tables and figures. Results From 6348 screened articles, 22 were included. The review reveals widespread misinformation concerning smoking, nutrition, blood pressure, weight management, alcohol consumption and diabetes care. Specific examples include misleading claims about e-cigarette safety and the downplaying of alcohol’s harms. A substantial proportion of social media posts falsely discourage salt reduction (reaching 1.5 million followers) and a significant number of diet/exercise vlogs (36.7%) and YouTube videos on myocardial infarction (one-third) contain inaccuracies, often originating from unreliable sources. Instagram, Facebook, YouTube and X were identified as key platforms for dissemination. Conclusion This review demonstrates that cardiovascular health misinformation is widespread and shaped by both platform dynamics and user-level factors. Addressing this challenge requires coordinated strategies that strengthen digital literacy, enhance visibility of evidence-based content and reduce the reach of misinformation. Collaborative efforts between public health agencies, clinical institutions and technology platforms are essential to ensure that trustworthy cardiovascular disease-related information reaches the public.

Abstract The rapid growth of digital platforms and e-commerce services has significantly transformed consumer purchasing behaviour. Many online businesses now adopt subscription-based models for delivering services such as entertainment streaming, software applications, and digital memberships. While these services offer convenience and continuous access to products and services, they have also led to the emergence of practices such as online subscription traps and hidden charges. Subscription traps occur when consumers are unknowingly enrolled in recurring payment schemes through misleading advertisements, unclear terms and conditions, or automatic renewal systems. Hidden charges, including undisclosed service fees, delivery charges, and taxes, often appear only at the final stage of payment, thereby affecting consumer decision-making. These practices raise serious concerns regarding transparency, fairness, and consumer rights in digital transactions. In India, the Consumer Protection Act, 2019 and regulatory oversight by the Central Consumer Protection Authority aim to protect consumers from unfair trade practices in online commerce. This study examines the level of consumer awareness regarding online subscription traps and hidden charges and evaluates the effectiveness of existing legal safeguards in protecting consumers. The research adopts a doctrinal and analytical methodology using secondary data from legal provisions, academic literature, and regulatory reports. The study concludes that although legal mechanisms exist to address deceptive practices, limited consumer awareness and complex digital marketing strategies continue to expose consumers to financial risks in online transactions. Keywords Consumer Awareness; Online Subscriptions; Hidden Charges; Consumer Protection Act, 2019; Digital Consumer Protection; Unfair Trade Practices; E-Commerce.

Background: Empathy is essential for effective patient care, improving communication, satisfaction, and compliance. This study was done to assess empathy levels in a tertiary care center in South India. Materials and Methods: A cross-sectional study among 40 physicians from various specialties assessed physician empathy using the Jefferson Scale of Physician Empathy–Health Professionals version (JSE-HP) and patient perceptions using the Jefferson Scale of Patient Perceptions of Physician Empathy (JSPPPE). Five patients per physician participated. Data were collected from January to June 2024, and was analyzed by a t-paired and ANOVA tests and a multilevel linear mixed-effects model. Results: A total of 200 patient–physician encounters were analyzed. Most physicians were under 50 years (90%), and patients were aged 19–85 years. Mean physician self-empathy (JSE) was 74.5 ± 8.6, and mean patient-perceived empathy (JSPPPE) was 31.0 ± 4.6. No correlation was observed between self- and patient-rated empathy (ρ = −0.06, p = 0.71). In multilevel analysis, self-empathy was not associated with patient-perceived empathy (β = −0.05, 95% CI [−0.15, 0.06], p = 0.37). Physician age, gender, and specialty were not significant predictors. The intraclass correlation coefficient (ICC = 0.066) indicated 7% of variance in patient empathy scores was due to physician-level differences. Conclusion: A disparity exists between physicians’ self-perceived and patient-rated empathy. Experienced physicians and those in patient-centered specialties are rated higher. Regular empathy training and feedback can align self-perceptions with patient expectations, improving communication and care quality.

Objectives: Diuretic therapy in liver cirrhosis is traditionally adjusted through a trial-and-error process, characterised by inefficiencies, frequent therapy modifications, prolonged hospital stays and high economic costs. Predictive analytics powered by machine learning (ML) offers a transformative solution, enabling personalised and precise interventions that minimise regimen changes, expedite recovery and enhance healthcare efficiency. This study evaluates the impact of ML-guided diuretic therapy on reducing treatment modifications, hospitalisations and associated costs, ultimately delivering precision-driven outcomes. Materials and Methods: An ambidirectional cohort study analysed 481 cirrhotic patients receiving diuretic therapy. Key clinical data, including liver function markers, serum electrolytes and urinary output, were collected to analyse therapy modifications and identify predictors of suboptimal outcomes. ML classification models were trained to predict optimal diuretic regimens using one-hot encoding for categorical variables. Model performance was assessed through the area under the curve, accuracy, sensitivity and specificity. Hyperparameter optimisation enhanced predictive accuracy, while feature importance analysis identified critical predictors of diuretic response. Results: Under the conventional approach, 71.5% of patients initially received suboptimal therapy, leading to add-on treatments (44%) or complete regimen changes (27%). The ML model reduced therapy modifications by 58%, achieving 81% accuracy in predicting optimal regimens. Key predictors of diuretic response included serum albumin, bilirubin and creatinine levels. Incorporating ML reduced the time to optimal therapy from 7–8 days to 4 days, shortened hospital stays by 40% and significantly lowered healthcare costs. Conclusion: ML-guided diuretic management in liver cirrhosis represents a paradigm shift, delivering precision-driven care that minimises therapy changes, shortens hospital stays and reduces economic burden. By leveraging key clinical predictors, this approach accelerates recovery and enhances treatment precision. Further validation in larger datasets and real-world settings is critical to establishing ML as a cornerstone of fluid management in cirrhosis, enabling cost-effective, patient-centred care.

Ultrasonography (USG) is a radiation-free imaging modality that provides real-time visualization of internal structures. This systematic review evaluates the role of USG in the management of zygomatic fractures. A systematic review was conducted following PRISMA guidelines. The literature searches in PubMed, Google Scholar, Semantic Scholar, and Cochrane Library (inception to October 2024) identified studies using intraoperative USG for zygomatic fracture reduction and fixation. Data on study characteristics, USG protocols, outcomes, and challenges were extracted. Risk of bias was assessed using the Joanna Briggs Institute (JBI) tool. Twelve studies (246 patients) were analyzed. USG was mainly used for fracture reduction of zygomaticomaxillary complex (ZMC) (N = 7) and isolated zygomatic arch(N = 5), with some applications in reduction and fixation. Linear probes with frequencies between 5 and 12MHz were commonly used. Challenges included limited visibility due to patient-related factors (swelling, tissue edema), USG-related limitations (low resolution, incorrect transducer frequency) and surgeon-related factors (learning curve, over-reduction errors). Post-operative CT/CBCT served as a reference to confirm USG's accuracy. USG shows potential as intraoperative imaging for reduction and fixation of ZMC fracture despite challenges such as limited visualization in cases of soft tissue swelling or deeply located fracture sites. The online version contains supplementary material available at 10.1007/s12663-025-02775-y.

Abstract Context: Patients with skin dermatophytosis can have subclinical dermatophytes in the nails, which can easily be missed on clinical examination. Dermatophytes may not be isolated from normal-appearing nails by KOH and culture, where it can serve as a reservoir for recurrent infection. Detection can be made by polymerase chain reaction (PCR), a more sensitive and faster technique. Aims: To detect the presence of dermatophytes in clinically unaffected nails by PCR in patients with skin dermatophytosis and to evaluate the diagnostic performance of KOH, culture, and PCR in detecting subclinical nail involvement. Materials and Methods: In this prospective observational study, 120 patients with skin KOH positivity had their nail clippings collected and sent for KOH, PCR, and culture. Results were tabulated, and statistical analysis was done. Results: Out of 120 patients, nail KOH revealed that 39 patients (32.5%) tested positive for dermatophytes, while 81 (67.5%) tested negative. Nail culture on Sabouraud dextrose agar (SDA) and dermatophyte test medium (DTM) showed dermatophyte growth in 44 patients: Trichophyton mentagrophytes (15.1%), Trichophyton rubrum (12.1%), Trichophyton tonsurans (4.2%), and unidentified dermatophytes (2.4%). PCR identified dermatophytes in 57 patients (47.5%). Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of KOH compared to PCR were found to be 68.4%, 100%, 100%, 77.8%, and 85% respectively; the same parameters for culture versus PCR were found to be 77.2%, 96.8%, 95.7%, 82.4%, and 87.5%, respectively, and for PCR versus culture were found to be 100%, 82.9%, 77.2%, 100%, and 89.2%, respectively. Conclusion: In patients with dermatophyte infection, nail PCR can detect subclinical infection in the nail, which may serve as a reservoir for ongoing infection and recurrence.

Despite strong evidence on the role of nutrition in secondary prevention of cardiovascular diseases, most cardiac discharge advises are generic and vague. This commentary advocates for a paradigm shift in post-discharge dietary counseling, positioning it as a critical, evidence-based tool for secondary prevention. Gathering evidence from global and interventional studies, we discuss the need for specific, prescriptive nutritional advice during discharge when patients are in the most receptive period. This commentary also briefs about the challenges that prevent clinicians from delivering meaningful dietary advice. We propose a multi-level strategy: integrating nutrition and behavior change counseling into medical education and licensing standards; building physician competence through experiential methods like culinary medicine; embedding structured dietary prescriptions into electronic health records; and ensuring consistent discharge summary quality through institutional policies and training. Furthermore, aligning policy reforms—including insurance coverage for nutrition counseling and food-is-medicine initiatives—will be essential to scale these interventions equitably. By redefining the role of nutrition in discharge planning, health systems can improve patient engagement, reduce readmissions, and contribute meaningfully to cardiovascular disease prevention and health system sustainability.