International Journal of Research in Medical Sciences
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Dystrophic epidermolysis bullosa: a comprehensive review of therapeutic strategies and the role of skin grafting in wound management and tissue regeneration
Full text linkDystrophic epidermolysis bullosa (DEB) is a severe inherited disorder caused by COL7A1 mutations, leading to deficient type VII collagen (COL7), chronic wounds, and fibrosis. Skin grafting-autologous, allogeneic, or bioengineered-offers potential for wound stabilization. This review evaluates grafting efficacy, limitations, and future directions. A systematic literature analysis (PubMed, Embase, Cochrane) highlighted clinical trials and mechanistic studies. Autologous grafts reduce wound burden but face donor-site fragility; allogeneic grafts provide temporary coverage but risk rejection. Bioengineered substitutes (e.g., gene-corrected autografts) show promise for COL7A1 restoration. While grafting remains palliative, gene-edited (e.g., CRISPR-Cas9) and tissue-engineered approaches may transform DEB care, necessitating multicenter trials for protocol standardization
Feeding practices among children 6-23 months attending in an outpatient department of a tertiary level hospital in Dhaka
Full text linkBackground: As malnutrition is not considered a disease, it remains a hidden health problem and quietly steals energy, retards growth and development, and lowers body resistance to infection. This study aimed to assess the feeding practices among children aged 6-23 months attending the outpatient department (OPD).
Methods: This cross-sectional study was conducted among 125 purposively selected mothers having children of 6 months to 2 years of age who attended the outpatient department of Holy Family Red Crescent Hospital. Face-to-face interview was done through questionnaires. Analysis of data was done with SPSS version 21.
Results: Among 125 respondent’s majority (66.4%) had their first child at the age of between 18-22 years. Only some of them (35.2%) had antenatal check-ups during pregnancy and most (88.8%) of the mothers did not have postnatal care after the delivery of the last child. Regarding the reason for not taking PNC nearly all (91.0%) did not know PNC. Maximum (56.8%) knew about feeding colostrum after childbirth and most (88.8%) feed colostrum to their child and almost all (95.2%) of them were only breastfeeding their child for six months.
Conclusions: The study highlighted a gap in maternal knowledge regarding antenatal and postnatal checkups, underscoring the need to raise awareness in these areas. However, most mothers demonstrated adequate awareness of proper breastfeeding practices, including colostrum feeding and complementary feeding
Acute pyogenic meningoencephalitis due to Streptococcus pneumoniae serotype 11A in a previously healthy child: a case report
Full text linkStreptococcus pneumoniae is a leading cause of bacterial meningitis in children despite the widespread use of pneumococcal conjugate vaccines (PCVs). We report a case of acute pyogenic meningoencephalitis in a 6-year-old previously healthy male child who presented with high-grade fever, vomiting, and neck stiffness. Cerebrospinal fluid (CSF) analysis revealed neutrophilic pleocytosis, elevated proteins, low glucose, and Gram-positive diplococci. CSF culture confirmed Streptococcus pneumoniae, later identified as serotype 11A - a non-vaccine serotype not covered by PCV10, PCV13, or PCV14. The child responded to intravenous ceftriaxone, vancomycin, dexamethasone, and supportive therapy. This case highlights the clinical features and management of pneumococcal meningoencephalitis due to serotype 11A, underlining the growing burden of non-vaccine serotypes and the importance of extended-serotype vaccines
Analysis of the De Ritis ratio in different diseases: an observation in a tertiary care hospital
Full text linkBackground: One useful biomarker for hepatic and extra-hepatic disorders is the De Ritis ratio of serum aspartate aminotransferase/ alanine aminotransferase (AST/ALT). There is growing evidence that it affects the prognosis of diseases related to the heart, metabolism, nervous system, and kidneys. In a tertiary care context, this study sought to assess its variation among age groups and systemic disorders.
Methods: Over the course of two months in 2025, a cross-sectional study was carried out at Peerless Hospital in Kolkata. There were 25 controls and 344 cases. Clinical diagnosis was used to categorize participants into groups related to gastrointestinal, cardiovascular, metabolic, neurological, kidney, and gynaecological conditions. The De Ritis ratio was computed and AST and ALT levels were tested. Data were stratified by age and analysed using Pearson correlation.
Results: The De Ritis ratio was elevated in all disease groups compared to controls. Cardiovascular patients aged between 31-60 years had the highest ratios. Metabolic, gastrointestinal, and neurological disorders showed progressive increases with age. Kidney disease (KD) patients had the highest ratios in elderly groups. Strong positive correlations were observed between gastrointestinal and neurological (r=0.95, p<0.00001), and between metabolic and neurological groups (r=0.75, p=0.0047). A strong negative correlation existed between cardiovascular and metabolic groups (r=-0.76, p=0.0044).
Conclusions: The De Ritis ratio's wide range of applications beyond hepatology is supported by the notable variance it exhibits with age and disease type. Our study demonstrates that it could be a helpful prognostic marker for a variety of systemic diseases
Exploring the interplay of body image, quality of life, self-esteem, and psychological well-being on eating attitudes in adolescents
Full text linkBackground: This study explores the associations between body image, quality of life (QOL), self-esteem, and psychological well-being with eating attitudes in adolescents. These psychological factors are theorized to influence the development of disordered eating.
Methods: A cross-sectional study was conducted with 100 adolescents aged 13-18 from private schools in Jaipur. Data collection used standardized tools: GHQ-12, EAT-26, BSQ-34, KIDSCREEN-27, and Rosenberg Self-Esteem Scale. Pearson correlations and independent t-tests were conducted using SPSS to explore relationships and group differences.
Results: Significant negative correlations were found between eating attitudes and both body image (r = -0.477, p<0.001) and QOL (r = -0.372, p<0.001). No significant correlations were found with self-esteem or psychological well-being. Likewise, t-tests showed significant differences in body image and QOL between problematic and non-problematic eaters, but not in self-esteem or well-being.
Conclusions: Body image and QOL significantly influence adolescents’ eating attitudes. Interventions should focus on these factors to prevent disordered eating, though self-esteem and general well-being may play a more indirect role
Genotyping and antifungal susceptibility profile of Candida albicans isolated from various clinical samples from tertiary care hospital
Full text linkBackground: Genotyping Candida albicans helps identify outbreaks, sources, and virulent and drug-resistant strains. PCR can identify Candida albicans isolates as A, B, or C based on transposable group I introns in 25S rDNA. The length of the amplified product divides C. albicans isolates into genotypes A, B, and C. Objective of this study was to determine Candida albicans genotypes and antifungal susceptibility in candidiasis patients using PCR.
Methods: HIV-positive vaginal and oropharyngeal swabs yielded 126 Candida albicans isolates. Germ tube development, chlamydospore formation, CHROM agar color, sugar fermentation, and auxanographic plate technique with sugar discs identified all C. albicans isolates phenotypically. E-test tested antifungal susceptibility. Genotyping was done using PCR. The Phenol: Chloroform method extracted genomic DNA from all C. albicans isolates. The primer pairs and sequence encompassed the 25Sr DNA transposable intron. 5'-ATA AGG GAA GTC GGC AAA GAT CCG TAA-3' and CA-INT-R (reverse): 5'-CCT TGG CTG TGG TTT CGC TAG ATA GTA GAT-3'.
Results: Out of all the 126 profiles, PCR examination of the 25S rDNA transposable group I intron indicated 68.3% genotype A, 10.3% genotype B, and 21.4% genotype C isolates. Genotype A had 16.3% fluconazole resistance, genotype B 7.7%, and genotype C 3.7%. Genotype A strains were resistant to caspofungin, amphotericin B, flucytosine, and voriconazole at 3.5%, 5.8%, 8.1%, and 8.2%. While genotype B and C strains were sensitive.
Conclusions: C. albicans genotyping advances drug resistance research. C. albicans molecular typing helps design infection control methods by studying its epidemiology and pathophysiology
Determinants of Doppler confirmed lower limb atherosclerosis in asymptomatic type 2 diabetes: cross-sectional evidence from a tertiary centre in South India
Full text linkBackground: Peripheral artery disease (PAD) in type 2 diabetes is frequently asymptomatic yet clinically significant, has multifactorial risk factors, the identification of which enable appropriate preventive strategies. Aims of study were-to identify clinical and biochemical determinants of Doppler‑confirmed lower‑limb atherosclerosis (PAD) in asymptomatic adults with type 2 diabetes and to establish the in- hospital prevalence of PAD in the study population. It was an observational cross‑sectional study conducted at a tertiary care centre in South India.
Methods: Adults ≥40 years with type 2 diabetes, asymptomatic for PAD were screened for PAD using colour duplex doppler, those with PAD were evaluated for demographic factors, diabetes duration, glycaemia (HbA1c), lipid profile, and diabetes complications [retinopathy, proteinuria/renal involvement, neuropathy, and coronary artery disease (CAD)]. Statistical analysis used was χ²/Fisher’s exact test for categorical variables and Welch’s t‑test for continuous variables. Analyses were performed in R, version 4.1.1
Results: Among 320 participants, PAD prevalence was 41.9% (n=134). PAD was associated with older age, longer diabetes duration, higher HbA1c, lower HDL and higher triglycerides, as well as retinopathy, proteinuria/renal involvement, neuropathy, and coronary artery disease (all p<0.001). Gender, LDL cholesterol and total cholesterol were not associated significantly with PAD (p>0.05).
Conclusions: Age, glycaemic burden, atherogenic dyslipidaemia, and microvascular/atherosclerotic comorbidities can help identify higher‑risk subgroups for targeted PAD screening in asymptomatic type 2 diabetes
Exploring the relationship between craniovertebral angle, hand grip strength and handwriting performance in students
Full text linkBackground: With the increasing reliance on mobile phones for communication, gaming, and internet use, musculoskeletal issues have become more prevalent, especially among students. Prolonged neck flexion, often associated with forward head posture (FHP), may compromise upper extremity function. Hand grip strength is considered a reliable indicator of upper limb integrity, while handwriting performance reflects fine motor coordination both potentially influenced by postural alignment. This study aimed to examine the relationship between craniovertebral angle (CVA), handwriting performance with hand grip strength among students.
Methods: An observational study was carried out over a 12-month period (June 2023–May 2024) at a tertiary care hospital in Southern Karnataka. A total of 77 students participated. CVA was measured using digital photogrammetry, hand grip strength with a handheld dynamometer, and handwriting performance through standardized writing tasks. Statistical analysis, including Pearson’s correlation, was conducted using statistical package for the social sciences (SPSS) version 21.0 to evaluate the relationships among the variables.
Results: The analysis found a weak, negative correlation between grip strength and handwriting (r=-0.06, p=0.606), indicating a lack of statistical significance. There was no significant correlation between CVA and hand grip strength, nor between hand grip strength and handwriting performance.
Conclusion: The findings suggest that in this student population, there is no significant association between craniovertebral angle, hand grip strength, and handwriting performance. However, generalizability is limited due to the homogeneous age group and restricted sample diversity
A case of toxic epidermal necrolysis in a paediatric patient with mycoplasma pneumoniae infection
Full text linkToxic Epidermal Necrolysis (TEN) is a rare, life-endangering emergency condition with a high mortality rate. While medications are recognized as common trigger factors, infections like Mycoplasma pneumoniae are also increasingly being recognized as other potential triggers, particularly in the paediatric population. A 6-year-old boy presented with fever, sore throat and tender skin lesions that rapidly progressed from erythema, macular rash to multiple vesicles, flaccid bullae and erosion, affecting more than 70% of total body surface area. Epidermal necrolysis affects more than 30% of the total body surface area including genital, oral and conjunctival mucus membranes. A diagnosis of Toxic Epidermal Necrolysis was established. Laboratory tests confirmed Mycoplasma pneumoniae infection and a chest Х-ray revealed pneumonia. For management of TEN, IVIG, followed by Methylprednisolone pulses were in combination. This was combined with antibacterial therapy and supportive care. The patient made a complete recovery with no complications after 36 days under Intensive Care. This case underscores Mycoplasma pneumoniae as a paediatric TEN trigger. It also serves to highlight the efficacy of combined immunotherapy and multidisciplinary care and the importance of early intervention in minimizing complications, especially in such severe cases.
Application of the Sydney system for classification and reporting lymph node cytopathology: a retrospective analysis at a tertiary centre
Full text linkBackground: Lymph node fine needle aspiration cytology (LN FNAC) is a minimally invasive, safe, quick, inexpensive and reliable diagnostic technique for evaluating lymph node (LN) pathologies, but the existing classification systems exhibits inconsistencies leading to diagnostic discrepancies and challenges in interobserver reproducibility. The Sydney system provides a standardised, tiered categorisation to improve diagnostic precision of LN cytopathology. This study aimed to analyse diagnostic performance of the Sydney system and evaluate its applicability in a tertiary care setting.
Methods: The retrospective observational study was conducted at tertiary care institution in India with 630 LN cytopathological cases, reviewed and reclassified using the Sydney system and compared with available histopathological correlations. The risk of malignancy was calculated for each category. Diagnostic performance metrics including sensitivity, specificity, positive predictive value, negative predictive value and diagnostic accuracy were evaluated with 95% CI.
Results: 630 LN FNAC samples were distributed as: L1, 19.7% (n=124); L2, 46.8% (n=295); L3, 1.1% (n=7); L4, 1.3% (n=8); L5, 31.1% (n=196). ROM increased progressively: L1, 0%; L2, 4.8%; L3, 66.7%; L4, 83.3%; L5, 98.5%. Diagnostic performance showed sensitivity 97.30%, specificity 93.02%, PPV 96%, NPV 95.24%, and accuracy 95.73%.
Conclusions: The Sydney system demonstrated high diagnostic accuracy and reliable risk stratification in a tertiary institution, reducing interobserver variability and enhancing patient management. Adoption of the Sydney system is recommended for standardised LN cytology reporting, with potential for ancillary techniques to refine indeterminate categories. This validation in a tertiary care institution supports the global applicability, particularly in high burden environments