Journal of Chemical Health Risks (Islamic Azad University, Iran)
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Ultrasound-Guided Combined Interscalene–Superficial Cervical Plexus Block versus Interscalene Block Alone for Surgical Anesthesia in Clavicle Fractures: A Comparative Study
No full textBackground: Regional anesthesia techniques for clavicular fracture surgery are increasingly used as safe alternatives to general anesthesia. The combined interscalene and superficial cervical plexus block may provide more complete anesthesia than interscalene block alone. This study compared the anesthetic efficacy of ultrasound-guided combined interscalene–superficial cervical plexus block versus interscalene block alone in clavicular fracture surgery.
Methods: A prospective comparative study was conducted on 50 adult patients undergoing clavicular fracture fixation from June 2024 to July 2025 at NITOR, Dhaka, Bangladesh. Patients were randomly allocated to Group A (combined interscalene and superficial cervical plexus block) or Group B (interscalene block alone). Both groups received 15 mL of 0.25% ropivacaine with 5 mg dexamethasone for the interscalene block; Group A received an additional 3 mL of 0.25% ropivacaine for the superficial cervical plexus block. Sensory block onset was assessed every 5 minutes using pin-prick, and motor block using the Modified Bromage Scale. Adequate anesthesia was confirmed prior to incision. Rescue analgesia with ketamine 50 mg and atropine 0.2 mg was given for intraoperative pain (VAS ≥ 4).
Results: Group A demonstrated significantly faster onset of sensory and motor block compared to Group B (p < 0.05). Fewer patients in Group A required rescue analgesia or conversion to general anesthesia (p < 0.05). Hemodynamic parameters remained stable in both groups. Minor complications, including breathlessness, bradycardia, and voice change, were slightly more frequent in Group A but were not statistically significant.
Conclusion: Ultrasound-guided combined interscalene–superficial cervical plexus block provides faster onset, more effective anesthesia, and greater safety than interscalene block alone for clavicular fracture surgery, reducing the need for rescue analgesia and conversion to general anesthesia
Perceived Benefit of Midwifery-Led Intervention and Its Association with Maternal and Neonatal Outcomes: A Statistical Analysis
No full textBackground. Midwifery-led models of care have been demonstrated to optimize maternal and neonatal health outcomes. Yet, women\u27s perceptions of such models might impact their effectiveness and may be varied based on their clinical experience. This research explores what determines demographic, clinical, and socio-economic influences on perceptions of midwifery-led models of care and whether such perceptions match true maternal and neonatal outcomes.Methods. Cross-sectional data were obtained in 500 women undergoing midwifery-led antenatal and intrapartum care. Participants were divided into three categories based on self-reported perception: Not Helpful (n = 178), somewhat Helpful (n = 164), and Very Helpful (n = 158). Demographic factors, clinical markers, neonatal complications, and maternal postpartum outcomes were recorded. Chi-square tests were employed in categorical variables, and ANOVA was employed to determine differences in continuous variables by perception groups.Results. No associations of significance were discovered between demographic factors including age, education, BMI, income, or occupation and perception of midwifery-led care (p > 0.05). However, clinical outcomes had a significant impact. Negative neonatal outcomes, i.e., preterm birth (p = 0.03) and respiratory distress (p < 0.05), were attributed to more negative expectations. Likewise, maternal complications in the form of postpartum haemorrhage (p = 0.04) and postpartum exhaustion (p = 0.06) were attributed to lower confidence in midwifery-led care. Mode of delivery had no correlation (p = 0.45).
Conclusion. Clinical outcomes, not demographic or socio-economic variables, influence women\u27s attitudes towards midwifery-led care. Fostering improved communication, patient education, and emergency preparedness could contribute to establishing trust and enhancing acceptance of this mode
Effect of Lifestyle-Based Weight Reduction on Asthma Control and Lung Function in Obese Individuals
No full textBackground: Obesity is a recognized risk factor for poor asthma control and reduced lung function. The coexistence of these conditions leads to a distinct clinical phenotype characterized by increased symptom burden and suboptimal response to therapy. Weight reduction through lifestyle modification may improve asthma outcomes, but evidence from Indian tertiary care settings remains limited.
Objective: To evaluate the effect of lifestyle-based weight reduction on asthma control and pulmonary function in obese adults with asthma attending a tertiary care hospital in North India.
Methods: This prospective interventional study included 80 obese asthmatic adults (BMI ≥30 kg/m²) followed over 12 months. Participants underwent a structured lifestyle intervention comprising dietary modification, regular aerobic exercise, and behavioral counseling. Asthma control was assessed using the Asthma Control Test (ACT), and spirometry parameters (FEV₁, FVC, FEV₁/FVC) were measured at baseline, 6 months, and 12 months according to ATS/ERS 2019 standards.
Results: Seventy-two participants completed the study. Mean BMI decreased from 33.8 ± 2.9 to 30.6 ± 2.4 kg/m² (p < 0.001). ACT scores improved from 17.3 ± 3.5 to 21.8 ± 2.9 (p < 0.001). FEV₁ (% predicted) increased from 68.4 ± 9.1 to 75.2 ± 8.7 (p = 0.002). Participants achieving ≥5% weight loss showed greater improvement in asthma control (ΔACT = 5.2 vs 2.1, p = 0.008). The degree of BMI reduction correlated positively with improvement in ACT (r = 0.41, p = 0.001) and FEV₁ (r = 0.34, p = 0.006).
Conclusion: Lifestyle-based weight reduction significantly improves asthma control and lung function in obese individuals. Incorporating structured weight management into standard asthma care may provide a non-pharmacological and sustainable approach to optimize patient outcomes
Foot Care Knowledge, Practices, and Diabetic Peripheral Neuropathy among Type 2 Diabetes Patients in a Tertiary care hospital, Tamil Nadu: A Mixed-Method Study
No full textBackground: Diabetes mellitus (DM) is a chronic metabolic disorder where foot complications significantly impact patients\u27 quality of life. Objectives were to assess the knowledge and practice of foot care and to find the prevalence and predictors of diabetic peripheral neuropathy (DPN) among type 2 diabetes mellitus patients.
Materials and Methodology: This mixed method study was conducted in outpatient department of General Medicine (Non-communicable disease clinic) of a tertiary care hospital from August 2024 to June 2025 among the type 2 Diabetes mellitus patients attending the NCD clinic. Pre-tested structured questionnaire was used to collect the quantitative data and In-depth interview for qualitative data. Chi square test and binary logistic regression were used to find association between the risk factors and DPN, and predictors of Diabetic Peripheral Neuropathy (DPN) respectively.
Results: The prevalence of DPN was found to be 37.8%. Around 96% of the participants had the knowledge of taking medications regularly to avoid diabetic complications and 96.5% of them had the practice of washing their feet regularly. Occupation, duration of diabetes and presence of other co-morbidities were associated with Diabetic peripheral neuropathy. Poor practice, abnormal body mass index, presence of other co-morbidities were found to be significant predictors of DPN. Lack of knowledge and physical limitation stated as reasons for poor foot care practices.
Conclusion: Despite good knowledge and foot care practices, factors such as poor practice habits, abnormal BMI, co-morbidities, and lifestyle factors like alcohol use were key predictors, underscoring the need for comprehensive diabetes management strategies
Taxonomic Diversity and Ecological Indices of Marine Gastropods Along the Alappuzha Coast, Kerala
No full textIntroduction: Marine gastropods are vital for benthic biodiversity in tropical coastal ecosystems. The Alappuzha coast along the southeastern Arabian Sea harbors diverse gastropod assemblages, yet taxonomic assessments remain limited. This study systematically documents gastropod species composition, abundance patterns, and economic potential in this region.
Objectives: To (1) collect and identify gastropod species from sandy beach habitats; (2) assess species richness, abundance, and distribution patterns; (3) calculate ecological diversity indices; ; (4) document economic importance for ornamental, edible, and therapeutic applications; and (5) identify biodiversity hotspots for conservation planning.
Methods: Field sampling occurred during January-April 2024 across 24 stations along the Alappuzha coast. Gastropods were collected from sandy substrates with morphological documentation. Biodiversity was assessed using Shannon-Wiener, Simpson, Margalef, and Pielou\u27s indices via PAST software.
Results: Twenty-five species representing 22 genera, 18 families, and 4 orders were documented. Neogastropoda dominated (14 species). Abundance ranged from 10-100 individuals. Thottappally was most diverse (H′ = 2.821, S = 18), while Tharayilkadavu and Arattupuzha showed lower diversity (H′ = 1.04, S = 3). Evenness indices (0.87-0.96) indicated uniform distributions. Twenty-four species (96%) had ornamental value, three were edible, and one had therapeutic applications.
Conclusions: This study establishes baseline gastropod biodiversity data for the Alappuzha coast. Thottappally emerges as a key biodiversity hotspot, while spatial variability suggests differential environmental quality. High ornamental value offers sustainable economic opportunities. Findings support biodiversity conservation, resource management, and monitoring programs under changing coastal conditions
Navigating the Long-Term Use of Proton Pump Inhibitors: Clinical Efficacy and Safety Concerns
No full textProton pump inhibitors (PPIs) have been extensively used for over two decades as the cornerstone therapy for acid-related gastrointestinal disorders, including gastroesophageal reflux disease, peptic ulcer disease, and Zollinger-Ellison syndrome. Their clinical efficacy in suppressing gastric acid secretion and promoting mucosal healing is well established. However, widespread and often prolonged use has prompted growing concerns regarding safety issues associated with long-term therapy. This article provides a comprehensive review of the current evidence on the clinical benefits and potential risks of extended PPI use. Common adverse effects such as nutrient malabsorption (magnesium, calcium, vitamin B12), increased susceptibility to infections (Clostridioides difficile, pneumonia), renal complications, and possible cardiovascular and gastrointestinal risks are discussed in detail. The role of pharmacovigilance data in monitoring these safety concerns is highlighted. Additionally, evidence-based deprescribing strategies are presented to guide appropriate tapering and discontinuation of PPIs when long-term use is not warranted. The critical involvement of clinicians and pharmacists in ensuring rational prescribing, patient education, and adverse effect management is emphasized. Lifestyle modifications that may reduce dependence on pharmacologic therapy are also reviewed. This balanced overview underscores the importance of individualized therapy, regular reassessment, and interdisciplinary collaboration to optimize patient outcomes while minimizing adverse events related to long-term PPI therapy.
DOI: https://doi.org/10.52783/jchr.v15.i6.1086
Association of Maternal Vitamin D Deficiency with Severity of Hypertensive Disorders of Pregnancy
No full textBackground: Vitamin D deficiency has been implicated in the pathogenesis of hypertensive disorders of pregnancy (HDP) through its effects on placental function, vascular health, and immune modulation. However, its relationship with disease severity remains inadequately characterized in Indian populations.
Aim: To assess the association of maternal vitamin D deficiency with the severity of hypertensive disorders of pregnancy.
Materials and Methods: This cross-sectional analytical study included 99 pregnant women diagnosed with HDP at a tertiary care hospital. Participants were categorized into gestational hypertension (GHTN), non-superimposed preeclampsia (NSPE), superimposed preeclampsia (SPE), and impending eclampsia (IE). Serum 25-hydroxyvitamin D levels were measured using chemiluminescent immunoassay (CLIA). Vitamin D deficiency was defined as <20 ng/mL. Maternal and fetal outcomes, including mode of delivery, NICU admission, and birth weight, were recorded. Data were analyzed using chi-square, ANOVA, and t-tests with significance set at p < 0.05.
Results: The overall prevalence of vitamin D deficiency was 76.5% (95% CI 67.2-83.8), with mean serum 25(OH)D = 14.51 ± 7.06 ng/mL. Deficiency was most frequent in SPE (90.9%) and NSPE (89.5%) compared to GHTN (67.4%). One-way ANOVA revealed a significant difference in vitamin D levels across HDP categories (F = 5.34, p = 0.002), with the lowest levels observed in severe preeclampsia. Maternal and neonatal outcomes showed no statistically significant correlation with vitamin D status (p > 0.05), although lower vitamin D tended to associate with preterm birth and NICU admission.
Conclusion: Vitamin D deficiency is highly prevalent among women with hypertensive disorders of pregnancy and is significantly associated with disease severity, particularly in preeclampsia. Screening and correction of vitamin D deficiency during antenatal care may serve as a cost-effective adjunct in reducing HDP-related morbidity
Comparison of Antimicrobial Efficacy of Calcium Hydroxide, 10% Bamboo Salt and Cerium Oxide Against Enterococcus Faecalis and Candida Albicans- An In Vitro Study
No full textBackground:
Persistent microorganisms like Enterococcus faecalis and Candida albicans challenge complete disinfection in endodontic therapy due to complex root canal anatomy. Traditional medicaments, such as calcium hydroxide, show limited efficacy.
Aim:
To evaluate and compare the antimicrobial efficacy of calcium hydroxide, 10% bamboo salt, and cerium oxide against E. faecalis and C. albicans.
Methods and Material:
Seventy-two decoronated, single-rooted premolars were instrumented and inoculated with E. faecalis (n=36) and C. albicans (n=36) for 21 days. They were divided into three groups based on the medicament used: calcium hydroxide, 10% bamboo salt, and cerium oxide. Medicaments were placed using lentulospirals and sealed with resin-modified glass ionomer cement. CFUs were evaluated on the 2nd and 7th days post-treatment.
Statistical Analysis Used:
Data were analyzed using Shapiro-Wilk and Levene’s tests in SPSS version 22.0.
Results:
10% bamboo salt showed the highest efficacy against E. faecalis, while calcium hydroxide was most effective against C. albicans. All medicaments significantly reduced microbial counts.
Conclusion:
Therefore, Bamboo Salt could be considered as a promising intracanal medicament for cases resistant to Calcium Hydroxide, though further in vivo research and clinical evaluations are essential for its validation
Liquid Biopsy vs. Tissue Biopsy in Guiding Genomic-Based Therapy for Lung Cancer: A Systematic Review & Meta-Analysis
No full textBackground: Precision medicine in lung cancer requires accurate genomic profiling to guide treatment decisions. While tissue biopsy is the established diagnostic standard, liquid biopsy has emerged as a minimally invasive alternative capable of capturing tumor heterogeneity and monitoring resistance mutations in real time.
Objectives: To systematically evaluate and compare the diagnostic accuracy and clinical utility of liquid biopsy versus tissue biopsy in guiding genomic-based therapy for lung cancer.
Methods: A systematic literature search was conducted across PubMed, Scopus, Embase, Web of Science, and Cochrane Library from January 2010 to June 2025. Studies assessing liquid biopsy (circulating tumor DNA/CTCs) versus tissue biopsy for genomic mutation detection relevant to targeted therapy selection were included. Meta-analysis was performed using a random-effects model to calculate pooled sensitivity, specificity, concordance, and impact on therapeutic outcomes.
Results: Twenty-seven eligible studies comprising 6,215 lung cancer patients were analyzed. The pooled sensitivity and specificity of liquid biopsy were 82% (95% CI: 77–86%) and 95% (95% CI: 92–97%), respectively, compared to tissue biopsy. Concordance between biopsy methods was 88%. Liquid biopsy demonstrated faster treatment initiation (7.3 vs. 19.2 days) and better detection of resistance mutations, particularly EGFR T790M (91% vs. 68%). Complication rates were significantly lower with liquid biopsy (1.8% vs. 9.5%).
Conclusion: Liquid biopsy is a reliable and non-invasive alternative for genomic profiling in lung cancer, particularly for resistance detection and treatment monitoring. A combined diagnostic strategy with tissue biopsy enhances precision therapy decision-making
An Open-Label, Single-Arm Clinical Trial to Evaluate the Effectiveness of Vishagna Mahakashaya in Urticaria with Special Reference to Dooshivishajanya Kotha and Its Effect on Serum IGE Level
No full textIntroduction: Urticaria is a common allergic manifestation that affects around 20% of individuals at least once in their lifetime. The modern era, characterized by altered diet and lifestyle and increased exposure to synthetic chemicals, leads to bioaccumulation of toxins similar to Dooshivisha in Ayurveda. Such toxins provoke hypersensitivity reactions manifested as Kotha (urticaria). Charaka has mentioned Vishagna Mahakashaya as an effective herbal combination for neutralizing and eliminating Visha (toxins).
Objectives: 1.To assess the clinical effectiveness of Charakokta Vishagna Mahakashaya in Dooshivishajanya Kotha (urticaria).2.To evaluate its effect on serum IgE levels
Methods: An open-label, single-arm clinical trial was conducted on 30 patients aged 20–50 years presenting with chronic urticaria (>6 weeks) and serum IgE >100 IU/ml. Vishagna Mahakashaya decoction (98 ml twice daily before food) was administered for 30 days. Assessment was done on days 1, 15, and 30 using subjective parameters (itching, burning, pricking sensation) and objective parameters (number and size of wheals per 24 hours). Serum IgE levels were measured on the 1st and 30th days. Statistical analysis was performed using paired t-test.
Results: The treatment showed statistically significant improvement (p < 0.001) in subjective and objective parameters. Serum IgE levels reduced significantly after 30 days, confirming the antiallergic and detoxifying effect of Vishagna Mahakashaya.
Conclusions Vishagna Mahakashaya effectively reduced urticarial symptoms and serum IgE levels, indicating its efficacy in Dooshivishajanya Kotha. The formulation may serve as a safe and holistic Ayurvedic alternative for allergic disorders linked to cumulative toxic exposure