Aims and background: Liver cirrhosis is a significant chronic disease that can be further complicated by sarcopenia. This study aimed to assess the prevalence of sarcopenia in patients with cirrhosis. Materials and methods: This prospective observational study was conducted at the Department of Medicine, Government Medical College, Jammu, from November 2021 to October 2022. A questionnaire was given to all patients with chronic liver disease, collecting their clinical history, examination findings, body mass index (BMI), mid-upper arm circumference, and skeletal muscle index (SMI) at the third lumbar vertebra (L3) vertebra. Results: A total of 82 patients were included in the study, of which 40 patients with sarcopenia. The mean age was comparable between patients with and without sarcopenia. The mean SMI at L3 of total study subjects was found to be 36.21 cm²/m². The weight (55.8 vs 68.2 kg), BMI (20.60 vs 25.60 kg/m²; p < 0.01), abdominal girth (90.50 vs 98 cm; p = 0.008), mid-arm circumference (MAC, 20.70 vs 24.50 cm; p < 0.01), and SMI at L3 (28.64 vs 40.31 cm²/m²; p < 0.01) were significantly lower in patients with sarcopenia compared to patients without sarcopenia. There was a significantly positive correlation observed between sarcopenia and BMI (r = 0.61; p = <0.01), abdominal girth (r = 0.54; p = <0.01), and MAC (r = 0.57; p = <0.01). The hepatic encephalopathy (HE) was significantly lower in patients with sarcopenia compared to patients without sarcopenia (15 vs 28.57%). Conclusion: A high prevalence of sarcopenia was observed in patients with chronic liver disease, but it did not show a correlation with established prognostic scores for liver cirrhosis, such as Model for End-stage Liver Disease (MELD) and Child-Turcotte-Pugh (CTP). Clinical significance: This study highlights the high prevalence of sarcopenia in patients with chronic liver disease, emphasizing the need for routine screening and early intervention. Despite its significant impact on physical health and muscle mass, sarcopenia did not correlate with established prognostic scores like MELD and CTP. These findings suggest that incorporating assessments of sarcopenia into the management of liver cirrhosis could improve patient outcomes by addressing an important yet often overlooked aspect of chronic liver disease.

Aim and introduction: Cancer patients undergoing radiotherapy need to adhere to complex self-care instructions to maintain overall health and manage local and systemic side effects. Patients frequently face challenges in recalling and effectively implementing these instructions, potentially affecting their self-efficacy and treatment outcomes. The teach-back method, an interactive technique in which patients are asked to repeat the instructions provided, has been shown to enhance understanding and retention. The aim was to assess effect of teach-back on recall of instructions and self-efficacy. Materials and methods: A posttest-only comparison group design was employed. Research settings were the oncology and radiotherapy outpatient department, in New Delhi. A total of 72 participants who were going to receive radiotherapy for the first time were randomly allocated (36 each) to experimental and control groups. Outcome variables included recall of instructions and self-efficacy which were assessed using recall checklist and self-efficacy rating scale. The assessment for the recall was done on day 1 and for self-efficacy on day 5. Results: Both groups were homogeneous in terms of recall of instructions and self-efficacy. In the experimental group, 94.7% had good recall and 5.3% had average recall, while in the comparison group 47.1% had good recall, 50% had average recall, and 2.9% had poor recall. In the experimental group, 94.4% had high self-efficacy, and 5.6% had average self-efficacy. In comparison group 69.4% had high self-efficacy and 30.6% had average self-efficacy. No correlation was found between recall of instruction and self-efficacy. Conclusion and clinical significance: “Teach-back” significantly improves the recall of instructions and self-efficacy. It can be used by healthcare providers in hospital and community settings.

Background: Heat-related illnesses (HRIs) are a significant public health concern, particularly in regions experiencing extreme temperatures. This observational study aims to evaluate the clinical, hematological, and biochemical spectrum of HRIs and identify prognostic markers, providing insights into mitigating their impact in Northwestern India. Methods: We conducted a hospital-based observational study involving 23 patients diagnosed with HRIs at Sawai Man Singh (SMS) Hospital, Jaipur, from May 31 to June 30, 2024. Adults over 18 years with clinical, hematological, and biochemical diagnoses of HRIs were included, while those with hyperthermia due to infections or drug use were excluded. Data were collected using a prestructured proforma that covered a comprehensive history, physical examination, and relevant investigations. Statistical analysis was performed using SPSS v20 and GraphPad Prism v5, with significant correlations determined through odds ratios (OR) and multiple logistic regression analysis. Results: The study cohort consisted of 23 patients, with a mean age of 54.6 years; males comprised 74% of the population. Fever was a universal symptom, and 96% (22/23) presented with altered sensorium. Key clinical and laboratory findings included leukocytosis (60%), elevated levels of aspartate aminotransferase (AST, 100%) and alanine aminotransferase (ALT, 78%), hyponatremia (74%), hypokalemia (45%), lactic acidosis (65%), and acute kidney injury (52%). Mortality was observed in 56.5% of patients, with significant associations found between mortality and leukocytosis (OR 3.5, p = 0.043) and elevated ALT levels (OR 5.2, p = 0.007). No significant correlation was noted between mortality and acute kidney injury or electrolyte disturbances. Multivariate analysis identified the need for mechanical ventilation as an independent predictor of mortality [OR: 12.45, 95% confidence intervals (CI): 1.02–152.62, p = 0.048], highlighting the severity of respiratory complications in heat stroke. Conclusion: This study identifies key clinical, hematological, and biochemical parameters associated with HRIs and highlights the need for targeted interventions to improve patient outcomes. The identification of prognostic markers such as leukocytosis and elevated ALT levels can guide clinical management and preventive strategies. Future research should focus on developing comprehensive prevention programs and exploring therapeutic advancements to reduce the burden of HRIs in vulnerable populations.

Aims and background: Pneumocephalus is a very rare complication after optic nerve sheath fenestration (ONSF). There are various mechanisms by which pneumocephalus can occur. The Dandy's ball valve mechanism defines a one-way movement of air into the cranial cavity produced by positive pressure events like coughing, while Horowitz's inverted soda bottle mechanism explains that air gets sucked into the skull due to pressure gradient triggered by negative intracranial pressure (ICP). In our case, postoperative persistent coughing resulting from postnasal dripping of cerebrospinal fluid (CSF) possibly caused the air to enter the cranial cavity through the surgically created bony defect, leading to pneumocephalus. The patient was managed conservatively with a successful outcome. Case description: A young female in her 30s was diagnosed as a case of idiopathic intracranial hypertension (IIH) with visual disturbances for the last 3 years. She underwent ONSF and postoperatively had pneumocephalus. On postoperative day (POD) 1, she had a headache, fever, and neck stiffness, for which a computed tomography (CT) scan of her head was done, which showed pneumocephalus. She was conservatively managed with intravenous (IV) antibiotics, 100% oxygen and bed rest with headend elevation. At the end of 1 week, her symptoms improved, and a repeat CT scan of her head after 8 weeks showed no pneumocephalus. Her vision had improved from 6/36 in the right eye to 6/6 and from finger counting close to the face in the left eye to 6/18 after surgery. Conclusion: Postoperative pneumocephalus after ONSF, though rare, should be carefully evaluated, and all causes should be mitigated to avoid adverse complications. Clinical significance: The bone over the intracanalicular part of the optic nerve, after being drilled, can act as a pathway between the nasal cavity and intracranial cavity through which air can enter the intracranial cavity, leading to pneumocephalus. Unilateral ONSF can have a beneficial effect on both the eyes and prevent further deterioration of vision.

Late termination of pregnancy is feasible in India after the amendment of the almost 50-year-old Medical Termination of Pregnancy Act of 1971, as the gestation age limit has been removed in cases of substantial fetal abnormalities. Such cases need to be thoroughly reviewed by the medical board and the combined decision must be taken along with informed consent of the parents. We came across a woman who developed rapidly progressive fetal lower urinary tract obstruction in the late second trimester of her pregnancy. We report the complete protocolized workup of such cases irrespective of gestational age, challenges in prognostication, and the decision for medical termination.

Single-cell analysis has emerged as a powerful tool in molecular biology, offering unprecedented resolution into the complexities and heterogeneity of biological systems at the cellular level. This technique surpasses traditional bulk analysis methods, which often obscure cellular diversity by analyzing populations of cells as a homogeneous entity. Single-cell analysis is revolutionizing our understanding of various biological processes and disease mechanisms by providing insights previously unattainable. As technological and computational methods continue to evolve, single-cell analysis is expected to experience a further expansion in its capabilities and applications, leading to breakthroughs in precision medicine and a deeper understanding of biological processes. The goal of this review is to provide a brief overview of how this technique has evolved, tracing its development from rudimentary genetic analytical tools to its current state as a highly sophisticated methodology. It includes a thorough summary of the methods and instruments used in single-cell analysis, particularly via ribonucleic acid (RNA) sequencing, the complexities of data analysis, benefits and drawbacks, and finally its clinical applications. The review will assist researchers in choosing and putting into practice the best methodologies for their research requirements.