Rabindranath Tagore Medical College

Objective: To evaluate the pattern of drug utilization, demographic characteristics, routes of administration, duration of hospital stay, and clinical outcomes in patients with myocardial infarction admitted to a tertiary care hospital. Methods: This was a hospital-based observational study conducted over a period of six months in the Pharmacology Department in coordination with the Cardiology Department of a tertiary care hospital in southern Rajasthan. A total of 100 patients with confirmed diagnosis of myocardial infarction were included. Data regarding demographics, drug prescriptions from admission to discharge, routes of administration, fixed-dose combinations, and clinical outcomes were collected from inpatient records and analysed descriptively. Results: The majority of patients were aged 61–70 y (37%), followed by 51–60 y (32%), with a marked male predominance (82%). Most patients recovered (93%), while in-hospital mortality was 7%. Combination routes of drug administration (oral, sublingual, and parenteral) were used in 84% of patients. Half of the patients had a hospital stay of 3–4 d. Antiplatelet drugs were prescribed to 99% of patients, with dual antiplatelet therapy being most common (73%). Statins (94%), beta-blockers (88%), anticoagulants (85%), and nitrates (89%) were widely used. Proton pump inhibitors were prescribed to all patients, while antibiotics were used in 51%. Fixed-dose combinations, particularly aspirin with clopidogrel and statins, were frequently prescribed. Conclusion: The study demonstrates a high level of adherence to evidence-based guidelines in the pharmacological management of myocardial infarction at the tertiary care hospital. The prescribing pattern reflects rational use of essential cardiovascular drugs and effective acute management, as evidenced by favourable clinical outcomes. However, the use of certain non-cardiac medications highlights the need for regular prescription audits to further promote rational drug use.

Acute lymphoblastic leukemia (ALL) is a neoplastic proliferation of immature hematopoietic cells, commonly presenting with anaemia, thrombocytopenia, neutropenia, or hepatosplenomegaly. Paraplegia as the initial manifestation is extremely rare. We report a 6-year-old girl presenting with backache and sudden paraplegia. MRI revealed a thoracic epidural mass (D1-D6). Tumor excision and laminectomy were performed, and histopathology confirmed B-cell ALL. This case highlights the importance of considering leukemia in children with acute spinal cord compression.

Metal-on-metal (MoM) joint replacements were designed to improve durability in younger, active patients. However, cobalt-induced cardiomyopathy (CIC) has emerged as a rare but serious complication, often misattributed to idiopathic or ischemic causes. We systematically reviewed published case reports, case series, and laboratory studies describing CIC in patients with MoM implants. Data extraction included clinical presentation, diagnostic criteria, treatment, and outcomes. Methodological quality and risk of bias were assessed qualitatively. Eighteen cases were included. Implant wear and corrosion released systemic cobalt, which localised in myocardial tissue. Pathophysiological mechanisms included mitochondrial dysfunction, oxidative stress, impaired calcium handling, and apoptotic injury. Patients commonly presented with non-specific cardiac symptoms such as fatigue, dyspnoea, orthopnoea, arrhythmias, and heart failure, alongside extra-cardiac features including hearing loss, thyroid dysfunction, and neurocognitive changes. Diagnostic confirmation required serum cobalt levels typically exceeding 30–100 µg/L, with cardiac MRI demonstrating non-ischemic fibrosis and oedema. Chelation therapy reduced cobalt burden but was rarely effective alone. Revision of the MoM implant consistently led to clinical improvement when performed early; delayed intervention was associated with irreversible myocardial damage and poorer outcomes. CIC is an under-recognised but potentially reversible form of cardiomyopathy. Routine cobalt screening and early implant revision are essential to prevent progression to heart failure or sudden cardiac death. Multidisciplinary collaboration between cardiology and orthopaedics is critical for the timely diagnosis and management of these conditions.Graphical

Chronic kidney disease (CKD) represents a growing global health burden marked by gradual and irreversible impairment of renal function.Conventional biomarkers such as serum creatinine, estimated glomerular filtration rate (eGFR), and albuminuria remain the mainstay for diagnosis and monitoring, yet they typically indicate renal injury only after considerable nephron damage has occurred.In recent years, numerous novel biomarkers have emerged, demonstrating greater accuracy and earlier detection of kidney dysfunction.These include soluble urokinase plasminogen activator receptor (suPAR), tumor necrosis factor receptors 1 and 2 (TNFR1 and TNFR2), neutrophil gelatinase-associated lipocalin (NGAL), kidney injury molecule-1 (KIM-1), and fibroblast growth factor 23 (FGF23).Additionally, molecular biomarkers such as circulating microRNAs (miRNAs) and urinary extracellular vesicles (uEVs) are gaining attention for their potential to improve disease prediction, assess progression, and guide therapeutic interventions in CKD.

Cancer screening programs are complex interventions involving multiple target groups, health professionals, civil society, and policymakers. Such complexity requires careful analysis of how stakeholders at micro, meso, and macro levels can both influence and be influenced by interventions. The Access Cancer Care India (ACCI) implementation research project aims to identify and codesign context-specific, integrated strategies for early detection of common cancers in India. This paper outlines stakeholder engagement strategies within ACCI, hypothesizing that engaging diverse actors through structured workshops will generate feasible and acceptable interventions to reduce diagnostic delays and strengthen early detection of cancer. Stakeholder mapping and influence assessment were conducted across macro (policymakers, program coordinators, Superintendents of district hospitals and oncology centers), meso (service providers, civil society, special interest groups, community health workers), and micro (community, patients) levels in Tamil Nadu, Kerala, and Rajasthan. Formative findings and potential interventions were shared in collaborative workshops where solutions were codesigned. Diverse stakeholders actively participated across all sites. Key individual-level barriers included fear, stigma, and in Rajasthan, patriarchal norms limiting women's care-seeking. System-level barriers spanned limited diagnostic capacity, weak health care coordination, and financial constraints. Facilitators included community campaigns using lived experiences, empowerment through self-help groups, and capacity building of providers (Auxiliary Nurse Midwives and Mid-Level Service Providers, especially in Kerala). Tamil Nadu highlighted the potential of cervical cancer self-sampling. A recurring theme across states was the urgent need for clear referral and patient navigation systems. Early, multilevel stakeholder engagement can surface critical barriers and codesign feasible, context-specific strategies to improve cancer detection. The ACCI model offers a replicable approach to reducing diagnostic delays and advancing equitable cancer care in low-resource settings.

There is a wealth of data indicating that the immune system plays an important role in seizure disorders. This includes autoimmune encephalitis, in which an immune response directed against neuronal antigens results in brain inflammation and subsequent seizure activity, as well as autoimmune‐associated epilepsy and neuroinflammatory changes detected in the tissues of patients with epilepsy, in which context it is often difficult to distinguish whether the inflammation is causal or a consequence of the seizures. Here, we summarize the discussion on this topic held during the XVII Workshop on Neurobiology of Epilepsy (WONOEP XVII), organized in 2023 by the Neurobiology Commission of the International League Against Epilepsy on the topic of the extracellular space in epilepsy. This critical appraisal explores the progress, emerging concepts, and discussion on the immunopathogenesis of epilepsy, with a particular focus on the interplay between the immune system and the central nervous system, highlighting the role of autoimmunity, neuroinflammation, and neuroimmunological processes in the etiology of various epileptic disorders and the prospects for new therapies.

Background & objectives: The purpose of this study was to determine differences in clinical outcome between subvastus and medial parapatellar approach in primary total knee arthroplasty. Methods: This is a prospective randomized study; we compared the clinical results of primary total knee arthroplasty using Subvastus and medial Parapatellar approaches in 80 patients. Patients are equally divided into both groups. Clinical outcome assessed using knee society score, time to return quadriceps function and visual analogue scale for pain. Results: The mean follow-up time was 3 months. Pain improved significantly overtime in both groups. However, when comparing groups together, patients in subvastus group had better numerical visual analogue scale score at 3rd day postoperatively, nevertheless, no significant differences found at other follow up times (8.17, 5.98, 4.37, 2.84, 1.56 for medial parapatellar group and 8.23, 4.16, 4.0, 1.86, 1.17 for subvastus group at preoperative, 3rd day, 2, 6 and 12 weeks postoperative respectively for both groups). Subvastus group had earlier return of quadriceps function which was significant statistically. Knee society score improved significantly overtime without any significant differences when comparing both groups together at any time of the follow up periods. Conclusions: Subvastus approach allowed earlier return of quadriceps function and less pain in the early postoperative day. In long term of functional outcome, none of two surgical approaches showed advantage over the other.