Rheumatoid arthritis (RA) is associated with pain, fatigue, anemia, sleep disturbances, and reduced functional capacity. Vitamin B12 deficiency may contribute to anemia and increase the overall disease burden in patients with RA. We conducted a mixed-methods clinical study among adults with RA, assessing hemoglobin and serum vitamin B12 levels alongside disease activity, sleep quality, and functional status using DAS28, PSQI, and HAQ-DI scores. Patients with vitamin B12 deficiency-associated anemia demonstrated higher disease activity, poorer sleep quality, and greater functional limitations. Lower hemoglobin and vitamin B12 levels were associated with increased DAS28, PSQI, and HAQ-DI scores. Qualitative findings further highlighted fatigue, sleep disturbances, restricted mobility, and difficulties with daily activities. This study emphasizes the importance of early detection and management of vitamin B12 deficiency-associated anemia as part of comprehensive RA care

Vitamin B12 Deficiency, Disease Activity, and Functional Outcomes in Rheumatoid Arthritis

Chronic Stress and Elevated Blood Pressure Among Medical Students

Hypertension and elevated blood pressure are increasingly reported among young adults, with chronic academic stress and unhealthy lifestyle habits potentially increasing cardiovascular risk. We conducted a cross-sectional study among 250 undergraduate medical students aged 18–26 years in Central India to assess the association between perceived stress, lifestyle factors, and blood pressure. Stress was assessed using the Perceived Stress Scale (PSS-10), while lifestyle habits and blood pressure were evaluated using structured assessments and standard measurement techniques. Elevated blood pressure was observed in 32.4% of students, with high stress strongly associated with elevated blood pressure (OR = 3.95). Low physical activity, smoking, short sleep duration, male gender, and unhealthy dietary habits were also identified as associated factors. These findings highlight the importance of early stress management and healthy lifestyle interventions to reduce cardiovascular risk among medical students.

Eswara Moorthy Gnanamurthy et al.

Melishia Sequeira et al.

Sudden cardiac arrest (SCA) is a life-threatening emergency in sports facilities where rapid recognition, cardiopulmonary resuscitation (CPR), and early defibrillation are essential for survival. We conducted a mixed-methods cross-sectional study among 150 participants, including athletes, coaches, and emergency responders, to assess SCA awareness and emergency preparedness. While awareness of SCA and CPR was generally high, important gaps were identified in cardiac arrest recognition, CPR knowledge, automated external defibrillator (AED) accessibility and training, emergency action-plan awareness, and response confidence. Previous CPR/BLS training was associated with substantially better preparedness. Qualitative findings highlighted limited training, inadequate AED accessibility, unfamiliarity with emergency procedures, and low confidence as key barriers. Regular CPR/BLS and AED training, accessible defibrillators, clear emergency protocols, and practical drills may improve preparedness and enable timely responses to sports-related cardiac emergencies.

Sudden Cardiac Arrest Preparedness Among Athletes, Coaches, and Emergency Responders

Good Syndrome in a Patient With Thymoma: A Rare Combined Immunodeficiency

Good syndrome is a rare adult-onset combined immunodeficiency associated with thymoma and characterised by hypogammaglobulinaemia, absent B lymphocytes, and impaired cellular immunity. An 82-year-old woman with newly diagnosed type AB thymoma presented with recurrent lower respiratory tract infections, lethargy, chronic watery diarrhoea, refractory oral candidiasis, poor oral intake, and significant weight loss. Investigations revealed severe panhypogammaglobulinaemia, complete absence of circulating CD19+ B lymphocytes, and reduced natural killer cells, confirming Good syndrome. She was treated with immunoglobulin replacement therapy and caspofungin for refractory candidiasis, resulting in significant clinical improvement. This case highlights the importance of recognising Good syndrome in patients with thymoma and recurrent infections. Early immunological assessment may facilitate timely diagnosis and treatment, reducing morbidity and improving outcomes.

Mirtha Munawwar et al.

Arvin Raju et al.

Carpal tunnel syndrome (CTS) is a common compressive neuropathy of the median nerve, with both endoscopic (ECTR) and open carpal tunnel release (OCTR) widely used as surgical treatments. We conducted a systematic review of studies published between 2012 and 2023 to compare the clinical outcomes and complications of ECTR and OCTR. Eleven studies, including seven randomized controlled trials and four meta-analyses, involving more than 8,000 procedures were included. ECTR demonstrated comparable or better outcomes in postoperative discomfort, functional recovery, grip strength, return to work, and patient satisfaction, with lower rates of scar sensitivity, pillar pain, and wound-related complications. However, ECTR was associated with a higher risk of reversible nerve injury. Both techniques were effective and generally safe, with surgical choice guided by patient preference, surgeon expertise, and the relative benefits and risks of each approach.

Endoscopic Versus Open Carpal Tunnel Release: A Systematic Review of Outcomes and Complications

Caregiver Burden and Support Needs in Families of Parkinson’s Disease Patients: A Mixed-Methods Study

Parkinson’s disease is a progressive neurodegenerative disorder that can place substantial emotional, physical, social, and financial demands on family caregivers. We conducted a mixed-methods cross-sectional study involving 102 family caregivers of patients with Parkinson’s disease to assess caregiver burden and support needs using a structured questionnaire and focus group discussions. Moderate-to-high caregiver burden was reported by 79.3% of participants and was significantly associated with longer caregiving duration, greater daily caregiving hours, advanced disease stage, and cognitive impairment in the care recipient. Qualitative findings highlighted emotional distress, social isolation, financial challenges, and unmet support needs, with caregivers identifying counselling, respite care, support groups, and financial assistance as important requirements. These findings emphasize the need for comprehensive caregiver-centered psychosocial support to improve caregiver well-being and sustain long-term care.

Ramkumar Rajapandian et al.

Misbah Shaikh et al.

Acute presentations of gastrointestinal malignancies can involve substantial symptom burden related to tumour progression and complications such as obstruction, bleeding, infection, and metabolic disturbances. We conducted a mixed-methods study among adults with gastrointestinal cancer presenting with acute symptoms to assess the relationship between patient-reported symptom burden and biochemical and radiological disease severity. Common symptoms included abdominal pain, anorexia, nausea and vomiting, fatigue, altered bowel habits, and weight loss. Higher symptom burden was frequently associated with anemia, hypoalbuminemia, raised inflammatory markers, abnormal liver function tests, and radiological evidence of advanced disease or acute complications. Qualitative findings highlighted significant effects on daily functioning, emotional well-being, and social life, while also demonstrating that perceived symptom severity did not always correspond with objective disease severity.

Patient-Reported Symptom Burden and Disease Severity in Acute Gastrointestinal Malignancies

Screen Time, Sleep Quality, and Behavioral Outcomes in School-Age Children

Screen time among children has increased substantially and may negatively affect sleep and behavioral well-being. We conducted a mixed-methods study involving 500 school-age children aged 6–12 years to evaluate the relationship between screen exposure, sleep quality, and behavioral outcomes. Screen time was assessed through parent-reported questionnaires and wrist-worn activity trackers, while behavioral outcomes were evaluated using the Strengths and Difficulties Questionnaire. Greater screen time was significantly associated with shorter sleep duration, lower sleep efficiency, and increased behavioral difficulties. Children with more than three hours of daily screen exposure slept approximately 45 minutes less than those with less than one hour of use. Interviews highlighted delayed bedtimes, nighttime device use, and difficulties with emotional regulation following evening screen exposure. These findings emphasize the importance of limiting excessive screen exposure and promoting healthy sleep routines to support behavioral and overall well-being in school-age children.

Sandra Mary Jose et al.

Maninder Singh et al.

Medication adherence is a major challenge among older adults taking multiple medications, with complex regimens, cognitive difficulties, adverse effects, and socioeconomic factors contributing to non-adherence. We conducted a mixed-methods observational study involving 100 elderly polypharmacy patients, with 20 participants additionally interviewed to explore barriers and facilitators to medication adherence. High adherence was observed in 42% of participants, moderate adherence in 35%, and low adherence in 23%. Lower adherence was associated with increasing medication burden and more complex dosing schedules. Qualitative findings identified forgetfulness, complex regimens, adverse effects, difficulty understanding instructions, and medication costs as important barriers, while family support, medication reminders, clear healthcare-provider communication, simplified regimens, and perceived health benefits facilitated adherence.

Medication Adherence Patterns in Elderly Patients With Polypharmacy: A Mixed-Methods Study

Diagnostic Decision-Making Patterns and Radiological Concordance in Diffuse Parenchymal Lung Diseases

Diffuse parenchymal lung diseases (DPLDs) present significant diagnostic challenges due to overlapping clinical and radiological features. This mixed-method, questionnaire-based study across 11 tertiary care centers included 218 pulmonologists, chest radiologists, and ILD specialists. Only 43.1% routinely used multidisciplinary discussion (MDD). Radiological concordance was moderate for UIP (κ=0.61), fair for NSIP (κ=0.42), and poor for indeterminate and hypersensitivity pneumonitis patterns (κ=0.29). ILD specialists demonstrated greater diagnostic confidence than general pulmonologists (p=0.003), while limited biopsy access, inadequate MDD infrastructure, and inconsistent guideline application were major barriers. Subspecialty training and institutional case volume independently predicted higher concordance. Structured MDD protocols, enhanced specialist training, and standardized HRCT reporting may improve diagnostic consistency and patient outcomes.

May Thara Phu Lwin et al.

Ishita Jayeshbhai Sanghani et al.

A prospective, single-centre closed-loop audit evaluated SHO knowledge and teaching compliance with the BOAST Peripheral Nerve Injury (PNI) Guidelines (2021) before and after a structured 60-minute teaching session. Twelve SHOs completed a 13-item BOAST-mapped MCQ assessing PNI principles, escalation thresholds, clinical scenarios, and training/governance. Mean scores increased from 8.82/13 (67.8%) to 12.09/13 (93.0%), while the proportion achieving ≥85% rose from 27% to 82%. Escalation timing, the weakest baseline domain at 50% correct, improved to 86.4%. All four audit standards were met post-teaching, and mean self-rated confidence increased from 2.36/5 to 4.09/5. The findings demonstrate that a structured BOAST-aligned teaching intervention can substantially improve SHO knowledge, compliance, and confidence, supporting its integration into SHO induction and ongoing departmental education.

Evaluation of SHO Knowledge and Teaching Compliance with BOAST Peripheral Nerve Injury

Management Variability of Acute Dysglycemia in Acute Coronary Syndrome

Acute dysglycemia is common in patients with acute coronary syndrome (ACS), yet management practices vary across cardiac emergency settings. This mixed-methods study included 100 ACS patients with dysglycemia and 30 treating physicians and residents. Hyperglycemia occurred in 72%, hypoglycemia in 12%, and mixed dysglycemia in 16% of patients. Glucose monitoring intervals varied, with only 41% consistently targeting 140–180 mg/dL. Insulin initiation thresholds also differed, with 46% initiating therapy above 180 mg/dL, 34% above 200 mg/dL, and 20% using individualized thresholds. Among clinicians, 67% reported absent or inadequate awareness of standardized protocols. Major barriers included time constraints (63%), limited protocol awareness (57%), uncertainty regarding insulin thresholds (53%), and concerns about hypoglycemia (47%). The findings highlight substantial variability in acute dysglycemia management and support standardized, evidence-based protocols, clinician education, and structured monitoring to improve consistency and safety in ACS care.

Preetam et al.

Chanda Karki et al.

Gelatinous transformation of the bone marrow (GTBM) is a rare condition usually associated with severe malnutrition, chronic illness, or malignancy. We report a previously healthy 33-year-old man who initially presented with fever and severe pancytopenia, with haemoglobin 3.8 g/dL, leucocyte count 1,030/µL, and platelets 20,000/µL. Bone marrow biopsy showed marked hypocellularity, fat-cell atrophy, and gelatinous extracellular material confirmed by Alcian blue staining, without evidence of acute leukaemia. Following supportive therapy, complete trilineage recovery was achieved. Nine weeks later, he returned with fever, musculoskeletal symptoms, and splenomegaly; leucocyte count had risen to 22,170/µL, with 27% blastoid cells on peripheral smear, and flow cytometry confirmed acute lymphoblastic leukaemia (ALL). This case highlights that unexplained GTBM with reversible pancytopenia may precede ALL, emphasizing the need for continued haematological surveillance despite apparent marrow recovery.

Marrow Recovery: Gelatinous Transformation Preceding Adultv Lymphoblastic Leukaemia

When “Type 2” Isn’t Type 2: IgG4-Related Disease Pancreatogenic Diabetes and Diabetic Ketoacidosis

Type 3c (pancreatogenic) diabetes may be overlooked in patients labelled as having type 2 diabetes, particularly when an underlying pancreatic disorder is unrecognized. We report a 54-year-old man with presumed type 2 diabetes treated with metformin alone who presented with severe diabetic ketoacidosis (DKA), with pH 7.14, glucose 46 mmol/L, ketones 6.7 mmol/L, bicarbonate 9.6 mmol/L, and HbA1c 123 mmol/mol. Markedly elevated serum IgG4 (6.86 g/L) and renal biopsy confirmed IgG4-related tubulointerstitial nephritis. Following corticosteroid and SGLT2 inhibitor therapy, he developed severe hyperglycaemia and recurrent DKA. Further testing showed low C-peptide (88.4 pmol/L) with negative islet autoantibodies, supporting type 3c diabetes secondary to IgG4-related pancreatic involvement. Basal-bolus insulin and treatment of the underlying disease improved glycaemic control. The case highlights the importance of reconsidering diabetes classification in patients with atypical progression, multi-organ disease, or unexpected insulin requirement to prevent delayed insulin therapy and DKA.

Monika Thelakar et al.

Jeyashree Mahendra Selvakumar et al.

This mixed-methods study evaluated cardiovascular risk perception, medication adherence, and lifestyle practices among 210 patients with type 2 diabetes mellitus (T2DM) and heart failure (HF). Mean age was 58.4 ± 9.7 years, with 54.3% male participants. Only 38.6% accurately perceived their cardiovascular risk, while 61.4% underestimated it. High medication adherence was observed in 46.7%, moderate adherence in 33.3%, and low adherence in 20.0% of participants. Adequate lifestyle modification, including diet, physical activity, and salt restriction, was practiced by only 29.5%. Accurate risk perception was significantly associated with better medication adherence (p<0.05). Qualitative findings identified financial constraints, low health literacy, symptom under-recognition, and inadequate physician–patient communication as key barriers. Targeted education, effective risk communication, and structured counselling may help improve self-management and long-term cardiovascular outcomes in this high-risk population.

Cardiovascular Risk Perception and Medication Adherence in T2DM With Heart Failure

Social Media, Sleep, Mental Health, and Academic Performance Among Students

Social media use can influence students’ sleep, mental well-being, and academic performance. This cross-sectional online survey assessed these associations among students at a tertiary care hospital using a validated Social Media Addiction Scale, along with measures of sleep quality, psychological well-being, mental health, and academic performance. Female students demonstrated better academic performance and lower levels of social media addiction than male students. Greater social media use was associated with increased sleep disturbances and psychological distress, particularly anxiety, with a mild negative association with academic performance. The findings suggest that excessive social media use may adversely affect sleep and mental well-being, potentially influencing academic outcomes. Promoting awareness and responsible social media use may help reduce these effects.

Niranjana Ananthan et al.

Rohan Sharma et al.

Type 2 diabetes mellitus (T2DM) is associated with increased cardiovascular morbidity and left ventricular diastolic dysfunction (LVDD). This study evaluated the relationship between glycaemic control, measured by HbA1c, and echocardiographic markers of LVDD in patients with T2DM. The findings suggest an association between poor glycaemic control and diastolic dysfunction, highlighting the potential cardiovascular impact of elevated HbA1c levels. Early echocardiographic screening and improved glycaemic control may help identify cardiac dysfunction and reduce long-term cardiovascular morbidity in patients with poorly controlled T2DM.

HbA1c and Left Ventricular Diastolic Dysfunction in Type 2 Diabetes

Fatigue, Menstrual Health, and Cognitive Function in Young Females With Iron Deficiency Anemia

This mixed-methods study evaluated fatigue, menstrual health, and cognitive function among 120 young females aged 18–35 years, including 60 with comorbid iron deficiency anemia (IDA) and fibromyalgia and 60 healthy controls. Cases had significantly higher fatigue scores than controls (6.4 ± 0.8 vs. 2.9 ± 0.6; p<0.001), while menstrual irregularities, including dysmenorrhea and heavy bleeding, were reported in 73.3% versus 21.7% (p<0.001). Mild cognitive impairment was identified in 68.3% of cases, with lower mean MoCA scores than controls (22.1 ± 2.4 vs. 27.6 ± 1.3; p<0.001). Qualitative findings highlighted brain fog, chronic exhaustion, and social withdrawal, while ferritin levels showed a significant negative correlation with fatigue severity (r=−0.61, p<0.001). The findings emphasize the need for early integrated screening and multidisciplinary management of young females with coexisting IDA and fibromyalgia.

Aparnna Unnikrishnan Nair et al.

Parvathy Sukumaran et al.

Digital health tools such as SMS, mobile applications, social media, and telehealth may improve access to adolescent health services by addressing barriers including stigma, confidentiality concerns, and geographical limitations. This review synthesized six verified studies published between 2021 and 2026 across the United States, South Africa, Sub-Saharan Africa, and global settings. Interactive digital interventions demonstrated improvements in contraceptive use and preventive health behaviours, including increased condom-protected sex and birth-control use. However, digital inequity, privacy concerns, connectivity limitations, and heterogeneous evidence remained important challenges. Digital health interventions show promise for improving adolescent health engagement and service uptake, but future approaches should emphasize equitable access, youth co-design, privacy, standardized outcomes, and long-term evaluation.

Digital Health Interventions to Improve Access to Adolescent Health Services: A Global Scoping Review

Sleep Duration and Cognitive Symptoms Among First-Year MBBS Students

A cross-sectional anonymous survey was conducted among 32 first-year MBBS students to assess sleep patterns and self-reported cognitive symptoms. Twelve students (37.5%) reported sleeping <6 hours per night, while 28 (87.5%) used mobile phones/laptops before sleep. Frequent memory difficulty was reported by 16 (50.0%), mental fatigue by 13 (40.6%), daytime sleepiness by 9 (28.1%), and concentration difficulty by 8 (25.0%). Although cognitive complaints were common, the small cross-sectional sample did not demonstrate a statistically significant association between sleep duration and individual cognitive symptoms. The findings highlight the need for greater attention to sleep health among medical students and larger studies using validated measures of sleep and cognition.

Mohammed Zahid Gauri et al.

Dishan Chatterjee et al.

A prospective mixed-methods observational study evaluated migraine-related disability and work productivity among 150 employed adults diagnosed according to the International Classification of Headache Disorders, 3rd edition. At baseline, 68.0% were women and the mean age was 34.8 ± 7.2 years. Over four months, significant reductions were observed in monthly migraine frequency (5.2 ± 2.4 to 3.8 ± 2.0 attacks; p < 0.001), attack duration (10.6 ± 4.3 to 8.7 ± 3.5 hours; p = 0.003), and pain severity (7.8 ± 1.4 to 6.4 ± 1.1; p < 0.001). Severe migraine-related disability decreased from 45.3% to 13.3%, with improvements in absenteeism, presenteeism, overall work impairment and activity impairment. Greater migraine severity was associated with higher productivity impairment. The findings highlight the occupational impact of migraine and support effective symptom management, coping strategies and supportive workplace accommodations to improve functioning and quality of life.

Migraine Disability and Work Productivity Among Employed Adults

Awareness and Practices of Cardiovascular Risk Prevention Among Diabetics

A cross-sectional study of 200 adults with type 2 diabetes assessed awareness and practices related to cardiovascular risk prevention and their association with glycemic and lipid control. Adequate awareness was reported by 59.0% of participants, while 52.0% demonstrated satisfactory preventive practices. Regular physical activity was reported by 41.0%, medication adherence by 73.0%, and routine lipid monitoring by 48.0%. Participants with adequate preventive practices had significantly lower HbA1c (7.4 ± 1.1% vs. 8.3 ± 1.4%; p < 0.001) and more favourable lipid profiles. Practice scores showed inverse correlations with HbA1c (r = −0.42), triglycerides (r = −0.29), and LDL cholesterol (r = −0.33; all p < 0.001). Common barriers included dietary challenges, inadequate exercise, medication concerns and limited understanding of cardiovascular risk targets. Strengthening patient education, lifestyle counselling, medication adherence and regular cardiovascular risk assessment may improve long-term outcomes in diabetes.

Devika Sunil Dutt et al.

Pranathi Danda et al.

Occupational heat stress is an increasing workplace health concern for outdoor workers in India, particularly those engaged in physically demanding work. A review of published Indian studies assessed heat exposure, related health problems and effects on work capacity. Evidence from 442 workers across 18 workplaces showed that 82% experienced heat exposure above recommended limits during hotter seasons, while 96% reported at least one heat-related symptom, including excessive sweating, thirst, fatigue, muscle cramps, headache, nausea and fainting. A 2026 study of 1,560 outdoor workers across 11 districts of Tamil Nadu found WBGT levels exceeding the critical 30°C threshold, with higher heat exposure associated with greater productivity loss. The findings highlight the need for workplace interventions including safe drinking water, shaded rest areas, regular breaks, heat-health education, adjusted working hours and avoidance of heavy work during peak heat periods.

Working in the Heat: Protecting Outdoor Workers from Occupational Heat Stress in India

Gastrointestinal Symptom Burden, Dietary Patterns, and Psychological Stress in Megaloblastic Anemia

A convergent mixed-methods study evaluated gastrointestinal symptoms, dietary patterns and psychological stress among 142 patients with megaloblastic anemia secondary to chronic gastritis (mean age 46.3 ± 12.7 years; 58.5% female). Indigestion and abdominal pain were the most prominent gastrointestinal symptoms, while 68.3% reported inadequate intake of vitamin B12-rich foods, with vegetarianism associated with lower serum B12 levels (p < 0.001). Moderate-to-high psychological stress was reported by 61.3% of participants and was positively associated with reflux and abdominal pain scores (r = 0.42, p < 0.01). Interviews with 22 patients highlighted fear of chronic illness, disrupted eating and restrictive dietary practices. Overall, the findings demonstrate an interconnected gastrointestinal, nutritional and psychological burden, supporting integrated management with dietary counselling, symptom-directed treatment, psychological support and haematinic replacement.

Mohammed Zahid Gauri et al.

Irshad Hassan et al.

This mixed-methods cross-sectional study assessed sudden cardiac arrest (SCA) preparedness among 150 individuals at a tertiary care sports facility, including 80 athletes, 40 coaches, and 30 emergency responders. While 85.3% were aware of SCA and 92.7% of CPR, only 65.3% knew the correct CPR sequence. Although 78.7% were aware of automated external defibrillators (AEDs), only 47.3% knew the location of the nearest AED and 42.0% had received AED training. Only 50.7% were aware of an emergency action plan, and 46.0% reported confidence in responding to SCA. Preparedness was substantially higher among those with previous CPR/BLS training (82.6% vs. 37.9%). Key barriers included inadequate training, limited AED accessibility awareness, poor familiarity with emergency procedures, and low confidence. Regular CPR/BLS and AED training, accessible defibrillators, clear emergency protocols, and periodic drills are essential to improve preparedness for sports-related cardiac emergencies.

Sudden Cardiac Arrest Preparedness Among Athletes, Coaches, and Emergency Responders

Janaki R et al.

Cesarean Section Trends and Influencing Factors in a Tertiary Care Center

This retrospective observational study evaluated cesarean section trends and influencing factors at a tertiary care center in Bengaluru, India, over five years from January 2021 to December 2025. A total of 1,146 lower segment cesarean section (LSCS) cases were analyzed using hospital records.Aged 21–30 years (68.67%), and emergency LSCS accounted for a substantial proportion of procedures. The most common indication was previous cesarean delivery (28.80%), followed by fetal distress (18.06%) and cesarean delivery on maternal request (12.22%). Emergency LSCS was performed in 79.72% of primigravida and 50.87% of multigravida women. Fetal distress was predominantly managed by emergency LSCS (204 emergency vs. 3 elective), while previous LSCS had a higher proportion of elective procedures (175 vs. 155 emergency). Among women aged <21 years, fetal distress, cephalopelvic disproportion, and severe pre-eclampsia/eclampsia were the leading indications.cesarean delivery and emergency obstetric indications to overall LSCS rates, emphasizing appropriate case selection and evidence-based obstetric practices.

KB Yuktha et al.