International Journal of Research in Medical Sciences
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Genetic modulator of stress resilience and blood pressure regulation: insights from polymorphic variation
Get PDFNeuropeptide Y (NPY) is a remarkably conserved neuropeptide distributed throughout the central and peripheral nervous systems, where it exerts broad influence over stress regulation and cardiovascular stability. While chronic stress typically contributes to increased blood pressure, a subset of individuals maintain normal levels despite similar stress exposure, suggesting the involvement of protective genetic factors within the NPY pathway. Variations in the NPY gene, particularly functional promoter polymorphisms such as rs16147 C>T and related haplotypes, appear to shape individual differences in stress responsiveness, sympathetic activation and emotional resilience. High-expression alleles are generally linked with reduced norepinephrine release, lower blood pressure and greater psychological stability under stress, whereas low-expression variants tend to enhance sympathetic tone and heighten vulnerability to anxiety and stress-related hypertension. Experimental studies reinforce the concept of NPY as a central sympathoinhibitory regulator, acting mainly through presynaptic Y₂ receptors within autonomic control centers. Recognizing these genetic influences offers valuable insight into why stress affects individuals so differently and opens new avenues for precision medicine. Genotypic profiling may ultimately aid in tailoring interventions for hypertension, anxiety and post-traumatic stress disorder. Moreover, pharmacological strategies targeting the NPY system such as Y₂ receptor agonists or agents that modulate epigenetic regulation, represents promising directions for future therapy. Continued longitudinal and translational research is essential to confirm causal mechanisms and to establish NPY as a clinically useful biomarker and therapeutic target in stress-related cardiovascular and neuropsychiatric disorders
Exploring healthcare providers’ perspectives on type 1 diabetes management in rural and resource-limited settings
Get PDFBackground: Type 1 diabetes mellitus (T1D) is a chronic autoimmune condition requiring lifelong insulin therapy and comprehensive care. In India, especially in rural and resource-limited settings, challenges in availability of insulin, provider training, patient education, and psychosocial support persist. Most studies emphasize patient experiences; however, healthcare providers’ perspectives remain underexplored.
Methods: A mixed-methods cross-sectional study was conducted among 82 healthcare providers, including endocrinologists, nurses, diabetes educators, and primary care physicians. Data were collected using structured questionnaires (quantitative) and semi-structured interviews/focus group discussions (qualitative). Quantitative data were analyzed using descriptive statistics, while qualitative transcripts underwent thematic analysis. Findings were integrated through convergent analysis.
Results: Among participants, 85% identified irregular insulin supply and affordability as major barriers, while 78% reported low patient awareness and literacy. Insufficient provider training (70%) and lack of systematic follow-up (65%) were also highlighted. Only 30% reported regular interdisciplinary coordination, and just 20% addressed psychosocial issues during consultations. Qualitative themes reinforced these findings, highlighting four domains: (1) systemic care barriers (supply shortages, workload, inadequate infrastructure), (2) patient engagement challenges (low literacy, stigma, myths), (3) limited team-based care (poor referrals, lack of formal coordination), and (4) neglected psychosocial support (absence of counseling, unmet family needs).
Conclusions: Providers face significant systemic, educational, and psychosocial challenges in managing T1D in rural India. Strengthening provider training, ensuring insulin availability, enhancing patient education, establishing multidisciplinary networks, and integrating psychosocial services are critical to improve outcomes
Optimizing outcomes in anal fissure treatment: Indian expert panel consensus on combination strategies
Get PDFAnal fissures, defined as longitudinal tears in the anoderm, are a common cause of severe anorectal pain, especially during defecation. Despite the availability of both pharmacological and surgical treatments, certain challenges persist in effectively managing chronic anal fissures (CAFs). This manuscript reviews the unmet needs in the management of anal fissures like high recurrence rates, side effects from existing treatments, improper application of topical agents and poor compliance. It also presents the recommendations from an expert panel of surgeons from all over India, aimed at addressing these issues. While standard surgical treatment, such as lateral internal sphincterotomy, is highly effective, it carries the risk of side effects, including fecal incontinence, which can significantly impact quality of life. Consequently, chemical sphincterotomy has emerged as a leading non-invasive approach, with topical agents such as diltiazem and lidocaine serving as key components in the management of anal fissures. The experts recommended the combination of diltiazem and lidocaine for its superior efficacy in promoting healing and reducing anal resting pressure, with fewer side effects than agents like nifedipine and glyceryl trinitrate. This combination offers a promising alternative for patients seeking non-surgical management of anal fissures.
Surgical management of horizontally impacted mandibular canine in a 10 years old child
Get PDFImpacted tooth refers to a tooth that fails to erupt into the dental arch within a specific time. Teeth frequently impacted are-third molars, maxillary canines, maxillary and mandibular premolars and maxillary central incisors. Failure of eruption of the mandibular canine is an unusual event. It has been suggested that eruption disturbances of a mandibular canine are most often caused by local factors such as mechanical obstruction (supernumerary tooth/cyst/tumour), insufficient space in the dental arch and tooth-arch size discrepancy. This case report presents surgical management of an impacted permanent mandibular canine of a 10 years old boy under local anaesthesia
Menstrual health practices in women with severe psychiatric disorders
Get PDFBackground: Menstrual hygiene constitutes an essential facet of women's health and dignity. Women diagnosed with severe mental illness frequently encounter obstacles in the maintenance of personal hygiene attributable to cognitive impairments, deficits in self-awareness and reliance on caregivers. Notwithstanding its critical importance, menstrual hygiene continues to be an overlooked dimension of mental health care for this demographic. To assess and compare menstrual hygiene practices among females with severe mental illness and healthy age-matched caregivers using the Menstrual Practice Needs Scale (MPNS-36).
Methods: This cross-sectional, comparative study was conducted at the Department of Psychiatry at Shadan Institute of Medical Sciences, Telangana. A total of 80 participants were recruited through consecutive sampling 40 clinically stable female patients diagnosed with schizophrenia, bipolar affective disorder or obsessive-compulsive disorder and 40 healthy female caregivers as controls. Sociodemographic and clinical details were collected using structured proformas. Menstrual hygiene practices were assessed using the MPNS-36. Data were analyzed using SPSS (22.0) and a p value of <0.05* was considered statistically significant.
Results: The mean age of patients and caregivers was 34.59±5.09 years and 31.14±6.33 years, respectively. Statistically significant differences were observed in domains related to comfort with menstrual materials, adequacy of supplies and worry about running out of materials. Other domains showed no significant intergroup differences.
Conclusions: Women diagnosed with severe mental illnesses exhibited both equivalent and inadequate menstrual hygiene practices in comparison to healthy control subjects. The incorporation of menstrual hygiene education within psychiatric rehabilitation programs is imperative for fostering comprehensive care
Framework for impact: evaluating research methodology workshop using CIPP model
Get PDFBackground: Research is an integral part of medical education, yet medical students often lack sufficient research skills, hindering evidence-based medicine. Research methodology workshop aim to enhance these competencies, but their effectiveness requires systematic evaluation. This study assessed the impact of an online research methodology and biostatistics workshop for final year undergraduate medical students using the content, input, process and product (CIPP) evaluation model.
Methods: A quasi-experimental study was conducted among 2,982 final-year Part-I undergraduate medical students from colleges affiliated with The Tamil Nadu Dr. M. G. R Medical University. The intervention involved periodic online workshops with interactive sessions led by expert facilitators. A 15-item semi-structured questionnaire was administered pre- and post-workshop to assess knowledge. The CIPP model guided evaluation.
Results: A significant improvement in research knowledge was observed following the workshop. The mean pre-test score increased from 7.67±3.22 to 9.37±2.20 post-test. The proportion of students scoring above the mean increased from 34.6% to 54.2%. Participants reported increased confidence in identifying study designs, formulating research questions, and interpreting statistical data. Qualitative feedback highlighted the workshop’s relevance, engagement, and value in fostering a research-oriented mindset.
Conclusions: The online workshop effectively enhanced research knowledge and competencies among medical students. Using the CIPP model, demonstrated the workshop’s role in fostering evidence-based practice and research culture. Early exposure to research methodology is vital for developing clinicians capable of contributing to medical advancements. Future studies should explore the long-term impact on research engagement and clinical practice
An experimental study on the effect of fatigue on agility and balance in male recreational football players
Get PDFBackground: Fatigue stands as a key injury contributor in sports, affecting attributes to such agility and balance. Although elite and sub elite athletes have been studied, the research gap lies in investigating fatigue's impact on agility and balance in recreational football players, which this study aims to address. The study aims to find out the effect of fatigue on these components in young men aged between 18-25 years.
Methods: A total of 40 male students aged 18-25 years volunteered to participate as subjects based on inclusion and exclusion criteria. The descriptive data age, weight and height were collected from each participant. Agility was assessed using T-test and balance was assessed using Y balance test. After taking their agility and balance scores, fatigue was induced in the participants via sprint fatigue tests. Pre- and post-values were collected for statistical analysis in order to assess the difference between agility and balance
Results: The average agility T-test score before inducing fatigue was 12.34 sec 93.42 and 92.47 for Y balance test in right and left respectively and 13.82sec 89.54 and 90.37 after inducing fatigue. The mean fatigue score among the test individuals was 93.32±5.66%.
Conclusions: The study concludes that with increase in fatigue persons agility and balance declines, which could lead to injuries. With this study we are reviewing that the negative effect of fatigue in male recreational players is similar to that in elite and sub elite population
The impact of NAFLD on diabetic complications in patients with T2DM
Get PDFBackground: This study investigates the relationship between non-alcoholic fatty liver disease (NAFLD) and type 2 diabetes, focusing on the associated macrovascular and microvascular complications. The aim is to assess the impact of the temporal sequence of these conditions on patient outcomes.
Methods: An observational study was conducted over three months (October 2023 to December 2023) at Katihar Medical College, enrolling 91 patients diagnosed with type 2 diabetes and NAFLD. Participants were grouped based on the duration of NAFLD and type 2 diabetes, and a range of clinical, laboratory, and diagnostic assessments were conducted to evaluate macrovascular and microvascular complications. Statistical analyses were performed to compare the groups.
Results: The study found that Group C had significantly higher BMI, WHR, triglycerides, ALT, AST, γ-GT, and uric acid levels compared to Groups A and B. The prevalence of CAD and hypertension was significantly higher in Group C. Group B had a longer NAFLD duration and higher ALT and AST levels than Group A. These findings suggest a strong association between metabolic dysfunction, NAFLD, and diabetic complications.
Conclusion: The study concludes that the temporal sequence of NAFLD and type 2 diabetes significantly influences the prevalence of macrovascular complications, particularly coronary artery disease and hypertension, in affected patients
Beyond the acronym, POEMS syndrome, a multisystemic enigma: a case report and comprehensive evidence-based perspective
Get PDFThe POEMS syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M protein and Skin changes) is a rare and complex disease involving a variety of body systems. Emphasis is placed on peripheral neuropathy and the presence of a monoclonal protein. Additionally, major and minor criteria, including bone lesions, elevated VEGF and Castleman's disease, are significant factors. On the therapeutic front, options range from radiotherapy to systemic therapy, underscoring the importance of an early treatment response. A 64-yearsold diabetic male, complain with weakness in lower limbs, along with edema and hyperpigmentation. He is diagnosed with neuropathy and CIDP is confirmed in EMG. An abdominal CT scan reveals hepatomegaly. Elevated proteins are identified as a finding in the liver function tests. Subsequent serum electrophoresis confirms an increase in M protein. Treatment with bortezomib and dexamethasone is initiated, resulting in clinical improvement. Despite this progress, the patient discontinues follow-up appointments. The POEMS syndrome is a diagnostic challenge, especially when primary symptom is polyneuropathy. The main key to diagnosis is the identification of the M protein through electrophoresis and immunofixation. A multidisciplinary diagnostic remains essential in addressing its complexity
Effect of high protein intervention on royal free hospital nutrition prioritising tool scores in patients with decompensated liver cirrhosis: a randomised control trial
Get PDFBackground: The Royal Free Hospital Nutrition Prioritising Tool (RFH-NPT) is an effective instrument for assessing the nutritional status of individuals suffering from cirrhosis, demonstrating high sensitivity and specificity in detecting malnutrition risk among patients with liver cirrhosis.
Methods: 110 male patients with decompensated cirrhosis were randomized, to a standard diet and a peptide supplement. The nutrition prioritizing tool, royal free hospital nutrition prioritising tool (RFH-NPT) was used to assess the effects on anthropometrics, dietary and biochemical markers. The statistically significance were analysed at p<0.05.
Results: The peptide group showed significant improvement in nutrition tool scores, malnutrition and body mass index compared with controls (0.64±1.20 vs. 4.76±1.70, p<0.00 at 95% CI).
Conclusions: The RFH-NPT is a valuable tool for identifying cirrhosis patients at risk of malnutrition, thereby allowing patients to receive nutritional care to improve their nutritional status and overall clinical outcomes