Punjab Institute of Medical Sciences

Tumors originating from the thymic epithelium are distinctly uncommon, and within this already rare group, atypical Type A thymoma represents an exceptional pathological diagnosis. Fewer than 20 well-substantiated cases have been documented in the international literature, with only isolated reports emerging from the Indian subcontinent. We present a rare case of atypical Type A thymoma identified following surgical excision of an anterior mediastinal mass in a middle-aged patient. Radiological evaluation revealed a localized thymic lesion without distinctive features suggestive of aggressive or atypical histology, underscoring the inherent limitations of pre-operative assessment in such neoplasms. The patient underwent complete thoracoscopic resection with curative intent. Detailed histopathological analysis of the excised specimen demonstrated architectural and cytological features diagnostic of atypical type a thymoma, a conclusion that could only be established after complete tumor removal. The post-operative course was uneventful, and resection margins were free of disease. This report highlights the diagnostic obscurity and extreme infrequency of atypical Type A thymoma, emphasizing the indispensable role of surgical excision in establishing an accurate diagnosis. Given the scarcity of reported cases and the limited representation from India, this case contributes meaningful insight to the existing body of evidence and may aid in improving recognition, pathological interpretation, and clinical understanding of this exceedingly rare thymic epithelial tumor

Background: Diabetes mellitus is a growing global health challenge, particularly in under-resourced coastal and rural regions where conventional healthcare access is limited. In these settings, communities often rely on traditional medicinal knowledge and locally available plants for managing diseases, including diabetes. Methods: An ethnobotanical survey was conducted over nine months (February–October 2023) in the coastal districts of Odisha, specifically in Balasore and Bhadrak. A total of 105 informants—including traditional healers, farmers, fisherfolk, and women-led self-help group members-were interviewed using semi-structured questionnaires, free listing, and field walks. Data were analyzed using key ethnobotanical indices such as Relative Frequency of Citation (RFC), Cultural Importance Index (CI), and Use Reports per Participant (UR/N). Results: Fifty medicinal plant species traditionally used for diabetes were documented. Terminalia pallida (RFC: 0.99, CI: 1.14, UR: 120) and Didymocarpus pedicellata (RFC: 0.99, CI: 1.10, UR: 115) were the most culturally and therapeutically valued species. Twenty-six polyherbal formulations were identified, with combinations like D. pedicellata + T. pallida (RFC: 0.99, CI: 1.05) and Syzygium cumini + Phyllanthus emblica (RFC: 0.97, CI: 0.91) rated as highly effective. These plant pairs are believed to exert synergistic effects on glycemic regulation and organ protection. Conclusions: The study highlights a rich, community-driven pharmacopoeia of antidiabetic plants, many of which influence key metabolic pathways such as AMP-activated Protein Kinase activation and oxidative stress modulation. These findings support further pharmacological validation of high-ranking species and their combinations. Traditional knowledge, when documented systematically, can guide the development of accessible, integrative antidiabetic therapies rooted in cultural and ecological sustainability. Keywords: Ethnobotany; Diabetes mellitus; Polyherbal formulation; Traditional medicine; Odisha; Synergistic phytotherapy

Background: Hypertension, or high blood pressure, is often called a “silent disease” because it typically shows no symptoms, leaving many individuals unaware of its presence. Despite the absence of warning signs, hypertension can significantly damage the body and increase the risk of heart disease and stroke. In today’s fast-paced world, understanding how stress influences blood pressure is vital. Stress has long been identified as a key risk factor for hypertension, alongside obesity, physical inactivity, and addictions such as smoking and alcohol use. The constant hassles, deadlines, and demands of modern life contribute to mental and psychosocial stress, which can elevate blood pressure over time. Methods: This study adopted a quantitative, quasi-experimental design (one-group pre-test and post-test) to examine the effect of abdominal deep breathing exercises on stress levels and blood pressure among 60 hypertensive patients in hospitals across Jalandhar, Punjab. Participants were divided equally into an experimental group (30) and a control group (30). The modified daily stress response scale and blood pressure assessment scale were used for data collection. Results: The experimental group practicing abdominal deep breathing exercises showed a statistically significant reduction (p<0.05) in both systolic and diastolic blood pressure and stress levels compared to the control group. Conclusions: Abdominal deep breathing proved to be an effective, low-cost, and non-invasive intervention for reducing stress and managing hypertension. Incorporating such techniques into traditional treatment strategies can enhance patient outcomes.

IntroductionTetraventricular hydrocephalus happens due to the fourth ventricle outlet obstruction. Idiopathic fourth ventricle outlet obstruction (IFVOO) is a condition where no clear-cut etiology for fourth ventricle outlet obstruction can be found. The etiopathogenesis of IFVOO is unclear. There is no clear-cut consensus regarding the treatment practices for its management. These cases present a diagnostic dilemma to the treating neurosurgeon and are thus often managed inappropriately. This study aims to review the existing literature regarding this condition, illustrating with a case from our hospital.Case DetailsWe present a case of a 50-year-old female who presented to us with the chief complaints of headache, difficulty in walking, with an inability to balance while standing and walking, diplopia, and three episodes of loss of consciousness for 6 months. A brain MRI was done, which was suggestive of dilatation of all ventricles with obstruction at the foramina of Luschka and Magendie. She underwent a right-sided, medium-pressure ventriculoperitoneal shunt at our hospital. Postsurgery, there was immediate improvement in her symptoms.ConclusionIFVOO is a rare cause of tetraventricular hydrocephalus with an unknown cause. Endoscopic third ventriculostomy (ETV) appears to have a higher risk of failure in such cases. Fenestration procedures after craniotomy and shunt procedures are still effective in their management. ETV is still an alternative to the above-mentioned procedures. To confirm these conclusions, larger studies involving multiple hospitals and institutes are required.

Type 2 diabetes mellitus (T2DM) remission has emerged as a critical area of research and clinical interest, especially in India, where diabetes prevalence is rising at an alarming rate. Achieving remission through pharmacologic, dietary, and surgical interventions is now an attainable goal for a subset of patients. This systematic review synthesizes evidence from clinical trials, emerging pharmacologic interventions, and current guidelines for diabetes remission. We explore the mechanisms of diabetes reversal, highlighting novel agents such as glucagon-like peptide-1 (GLP-1) receptor agonists, dual glucose-dependent insulinotropic polypeptide (GIP)/GLP-1 agonists, and sodium-glucose cotransporter 2 (SGLT2) inhibitors. This review also addresses the long-term sustainability of remission, epidemiological trends in India, and current treatment recommendations, integrating data from major studies. The findings underscore the need for a patient-centered, evidence-based approach to diabetes management. Additionally, we discuss the role of continuous glucose monitoring (CGM), dietary interventions, and the benefits of millet consumption in diabetes remission.

Objectives: This study aimed to analyze the incidence, types, and risk factors associated with central venous catheter (CVC) insertion complications in a tertiary care center in India. It sought to evaluate the impact of insertion techniques (ultrasound-guided vs. landmark) and anatomical sites on complication rates, while addressing barriers to ultrasound adoption in the Indian healthcare context. Methodology: A retrospective cohort study was conducted at a single center in Punjab, analyzing 1264 CVC insertions performed between July 2021 and December 2023. Data were extracted from electronic and paper medical records, including patient demographics, insertion site (subclavian, internal jugular [IJV], and femoral), technique (ultrasound-guided or landmark), catheter type, and complications (early: Arterial puncture, pneumothorax; delayed: Infection, thrombosis). Statistical analyses included descriptive statistics, Chi-square tests, and ANOVA to compare outcomes. Results: The overall complication rate was 8.15% (early: 5.62%, delayed: 2.53%). Subclavian insertions were most common (71.7%), followed by femoral (16.2%) and IJV (12.1%). Ultrasound guidance was used in only 9.3% of cases but demonstrated zero early complications in subclavian insertions ( P = 0.01). Femoral catheters had the highest thrombosis rate (2.9%) and shortest dwell time (median 3 days). Infection rates (1.36 per 1000 catheter days) showed no correlation with dwell time ( P = 0.612). The landmark technique predominated (90.7%), with low pneumothorax rates (0.2%) despite high subclavian use. Conclusion: This study highlights the safety benefits of ultrasound guidance, particularly for subclavian CVCs, and underscores the need for policy reforms to overcome barriers to its adoption in India. Femoral catheters, despite shorter dwell times, posed higher thrombosis risks, suggesting careful site selection is critical. Standardized protocols and targeted training could further reduce complications in resource-limited settings.

Background: The peer review process is widely accepted to benefit the education of health professionals. However, formal experience in peer reviewing is rare at the undergraduate level. A substantial pool of potential reviewers exists among health profession students, who are as rigorous in peer reviewing as those with more experience. In this study, we aimed to evaluate the impact of a mentorship experience designed to teach health professions students peer review skills using experienced peer reviewers as mentors. Methods: Within the student organization section of The Network: Towards Unity for Health (SNO), student leaders hosted student-led journal clubs. Active SNO students were directly recruited and paired with experienced journal reviewers who served as their mentors. Each mentor/mentee pairing independently reviewed an article for either the journals Education for Health or Undergraduate Research in Health. They then met to discuss the results and provide feedback. Students who completed at least two reviews “graduated” from mentorship and were invited to join the pool of journal reviewers. Results: The program effectively guided students to become effective peer reviewers. Students reported several benefits to participating in the program, including feeling more confident as peer reviewers, feeling more effective at delivering constructive feedback, and experiencing personal growth, such as becoming more effective at designing their research. Discussion: A mentor/mentee peer review experience effectively produced a pool of competent peer reviewers while providing participants with several opportunities for personal growth. Ultimately, similar programs could lead to a larger community of peer reviewers and improved research literacy and capabilities among health professions students.

Background: Stroke is a major global health threat, with high systolic blood pressure (HSBP) as its leading modifiable risk factor. G20 nations—home to over 60% of the world’s population—face a growing burden driven by demographic shifts and uneven health policies. Despite their resources, comparative assessments of HSBP-attributable stroke trends across G20 countries remain scarce. Methods: Using the GBD 2021 analytical framework, we estimated the stroke burden attributable to HSBP in G20 countries from 1990-2021, stratified by age, sex, year, and location. Age-standardized mortality rates (ASMR), disability adjusted life years (DALYs) (ASDALR), years lived with disability (YLDs) (ASYLDsR), and counts were analyzed, and temporal trends were quantified using estimated annual percentage change (APC). Result: From 1990 to 2021, stroke deaths attributable to HSBP in G20 countries rose from 2.0 million (95% UI: 1.5–2.5) to 3.0 million (2.2–3.8), DALYs increased from 46.2 million (34.7–57.3) to 64.4 million (48.1–80.0), and YLDs doubled from 3.0 million (2.0–4.1) to 6.2 million (4.1–8.5). Age-standardized rates showed modest annual percentage declines: ASMR by 0.4%, ASDALR by 0.37%, and ASYLDR by 0.04%. Nationally, South Africa recorded the highest rise in ASMR (APC: +0.54%), followed by Indonesia (+0.33%), while most countries showed a downward trend. For ASYLDR, China reported the steepest increase (APC: +1.11%), followed by Indonesia (+0.025%), whereas the U.S. experienced a notable decline (−0.55%). By age, the highest unadjusted death rate in 2021 occurred in individuals aged ≥55 years [251 (186–315) per 100,000], compared to 8.47 (5.99–10.78) in those aged 20–54. Sex-wise, males experienced a greater burden increase than females from 1990–2021: deaths rose by 65% vs 29%, DALYs by 54% vs 25%, and YLDs by 118% vs 96%. Conclusion: In 2021, G20 countries accounted for 72.41% of global stroke deaths attributable to HSBP, while within the G20, 57.84% of all stroke deaths were attributed to HSBP. Despite overall declines in age-standardized rates, the rising absolute burden of stroke attributable to HSBP—particularly among males, older adults, and emerging G20 economies—highlights the urgent need for targeted hypertension control strategies and equitable stroke prevention efforts.