International Journal of Public Research in Medicine and Health
Launched in September 2025, the International Journal of Public Research in Medicine and Health (IJPRMH) is a multidisciplinary, online-only, open-access, peer-reviewed journal dedicated to advancing research across medical, dental, and allied health sciences. The journal provides a dynamic global platform for high-quality original research, systematic reviews, meta-analyses, case reports, and policy-related scholarship that contribute to improved clinical practice, public health systems, and evidence-based decision-making. IJPRMH is committed to upholding the highest standards of academic publishing, emphasizing methodological rigor, ethical integrity, scientific relevance, and transparent editorial processes. By enabling rapid yet robust peer review and ensuring global visibility, the journal seeks to bridge the gap between research and practice while fostering collaboration among clinicians, researchers, academicians, and policymakers worldwide.
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Clinical Predictors of Large Vessel Occlusion and Diagnostic Accuracy of Non-Contrast CT in Acute Ischemic Stroke: A Cross-Sectional Study
Received: 20-06-2026 Revised: 27-06-2026 Accepted: 29-06-2026 Introduction: Large vessel occlusion (LVO) is a major determinant of morbidity and mortality in acute ischemic stroke (AIS), requiring rapid identification for timely reperfusion therapy. While computed tomography angiography (CTA) is the reference standard for detecting LVO, non-contrast computed tomography (NCCT) remains the most widely accessible imaging modality in many healthcare settings. This study evaluated clinical predictors of LVO and assessed the diagnostic performance of NCCT against CTA-confirmed occlusion. Methods: A hospital-based cross-sectional study was conducted among 72 consecutive adults presenting with suspected AIS who underwent both NCCT and CTA. Demographic characteristics, clinical presentations, vascular risk factors, and imaging findings were analyzed. Multivariable logistic regression was used to identify independent predictors of LVO. Diagnostic accuracy parameters of NCCT were calculated using CTA as the reference standard. Results: CTA confirmed LVO in 43 patients (59.7%). The middle cerebral artery was the most commonly affected vessel (69.8%). Hemiparesis showed a significant association with LVO (OR 2.89, 95% CI: 1.08–7.73; p=0.034) and remained the only independent predictor on multivariable analysis (adjusted OR 3.06, 95% CI: 1.09–8.61; p=0.034). NCCT demonstrated a sensitivity of 88.4%, specificity of 72.4%, positive predictive value of 82.6%, negative predictive value of 80.8%, and overall diagnostic accuracy of 81.9% for detecting CTA-confirmed LVO. Conclusion: LVO was common among patients presenting with suspected AIS. Hemiparesis independently predicted the presence of LVO, while NCCT exhibited high sensitivity and satisfactory diagnostic accuracy. Integration of clinical assessment with NCCT findings may facilitate early triage and prompt referral for advanced stroke management, particularly in resource-limited settings.
Copyright (c) 2026 Keepa Suryabanshi, Aakash Yousuf, Aaseem Anand (Author) https://creativecommons.org/licenses/by/4.0
Artificial Intelligence–Driven Scientific Misconduct: Synthetic Data, AI-Generated Manuscripts, And Emerging Threats to Research Integrity—A Narrative Review
Received: 17-06-2026 Revised: 24-06-2026 Accepted: 26-06-2026 The rapid integration of generative artificial intelligence (AI) into scholarly publishing has transformed scientific communication, offering unprecedented opportunities for literature synthesis, language enhancement, data analysis, and manuscript preparation. Simultaneously, these technologies have created new avenues for scientific misconduct, including fabrication of synthetic datasets, generation of misleading manuscripts, production of hallucinated references, semantic plagiarism, and large-scale publication fraud facilitated by paper mills. This narrative review examines the evolving landscape of AI-driven scientific misconduct and its implications for research integrity. Drawing upon recent empirical studies, research integrity reports, policy documents, and scholarly commentaries published between 2020 and 2025, the review synthesizes current evidence regarding emerging forms of misconduct enabled by generative AI technologies. Particular attention is given to synthetic data fabrication, AI-assisted authorship, citation manipulation, paper-mill operations, and challenges associated with detecting increasingly sophisticated fraudulent content. The review further discusses the impact of these practices on evidence synthesis, reproducibility, academic evaluation systems, and clinical decision-making. Recognizing that AI is neither inherently beneficial nor inherently harmful, the article also highlights legitimate applications of AI in research and publishing, including plagiarism detection, image forensics, editorial support, and enhancement of research accessibility. Current evidence suggests that while concerns regarding AI-enabled misconduct are well founded, substantial knowledge gaps remain regarding its prevalence, detection, and long-term consequences. Protecting research integrity in the AI era will require coordinated efforts involving researchers, publishers, institutions, funders, and regulatory organizations to ensure transparency, accountability, and responsible use of emerging technologies.
Copyright (c) 2026 Abid Manzoor, Sana Rafiq khuroo, Sunny Basra (Author) https://creativecommons.org/licenses/by/4.0
Clinicopathological Spectrum of Abnormal Uterine Bleeding in Perimenopausal Women: A Histopathological Study
Received: 07-06-2026 Revised: 17-06-2026 Accepted: 22-06-2026 Introduction: Abnormal uterine bleeding (AUB) is a common gynecological complaint among perimenopausal women and may represent a spectrum of endometrial changes ranging from physiological hormonal alterations to premalignant and malignant lesions. Histopathological evaluation remains the definitive diagnostic modality for identifying the underlying pathology and guiding management. Materials and Methods: A hospital-based cross-sectional study was conducted on 320 perimenopausal women aged 40–55 years presenting with AUB who underwent endometrial sampling. Clinical, demographic, and ultrasonographic data were recorded. Endometrial specimens obtained through biopsy, curettage, or hysterectomy were processed and examined histopathologically according to contemporary WHO criteria. Associations between clinicopathological variables were analyzed using appropriate statistical tests and multivariable logistic regression. Results: The mean age of participants was 47.8 ± 4.2 years. Heavy menstrual bleeding was the predominant presentation (40.6%). Histopathological examination revealed proliferative endometrium as the most frequent finding (28.8%), followed by secretory endometrium (15.0%) and disordered proliferative endometrium (13.1%). Endometrial hyperplasia without atypia and atypical hyperplasia/endometrial intraepithelial neoplasia were identified in 12.2% and 4.1% of cases, respectively. Endometrial carcinoma was diagnosed in 4.0% of women. Endometrial thickness >12 mm showed a significant association with premalignant and malignant lesions (p<0.001). Multivariable analysis identified age ≥50 years, obesity, diabetes mellitus, and endometrial thickness >12 mm as independent predictors of significant endometrial pathology. Conclusion: Functional endometrial alterations constitute the majority of AUB cases in perimenopausal women; however, a substantial proportion harbor premalignant or malignant lesions. Endometrial sampling remains indispensable for early detection, particularly in women with advanced age, obesity, diabetes, and increased endometrial thickness.
Copyright (c) 2026 Shazia Iqbal, Pratiksha Shrestha, Sumanjari Pradhan (Author) https://creativecommons.org/licenses/by/4.0
Stigma Toward Mental Illness Among Healthcare Professionals In A Tertiary Care Hospital
Received: 16-06-2026 Revised: 20-06-2026 Accepted: 23-06-2026 Introduction: Stigma toward mental illness among healthcare professionals remains a significant barrier to equitable and effective mental healthcare. Negative attitudes among healthcare providers can adversely affect patient outcomes, delay help-seeking, and compromise therapeutic relationships. This study assessed the prevalence and determinants of stigma toward mental illness among healthcare professionals working in a tertiary care hospital. Methods: A hospital-based cross-sectional study was conducted among 422 healthcare professionals, including doctors, nurses, and allied health personnel. Participants completed a structured online questionnaire comprising the Community Attitudes toward the Mentally Ill (CAMI) scale, Opening Minds Stigma Scale for Health Care Providers (OMS-HC), Modified Bogardus Social Distance Scale, and Mental Health Knowledge Schedule (MAKS). Associations between stigma scores and demographic or professional characteristics were analyzed using t-tests, ANOVA, correlation analysis, and multiple linear regression. Results: The mean CAMI total score was 112.6 ± 18.4, indicating a moderate level of stigma. Nurses demonstrated significantly higher stigma scores than doctors and allied health professionals across all assessment scales (p<0.001). Overall, 28.9% of participants were categorized as having high stigma, with the highest prevalence among nurses (44.7%). Healthcare professionals working in psychiatry settings, those with prior psychiatry training, and those reporting personal or family experience of mental illness exhibited significantly lower stigma levels (all p<0.001). Mental health knowledge showed a moderate inverse correlation with stigma (r = −0.41, p<0.001). In multivariable analysis, nursing profession emerged as the strongest independent predictor of higher stigma, whereas prior psychiatry training and personal history of mental illness independently predicted lower stigma scores. Conclusion: Stigmatizing attitudes toward mental illness remain common among healthcare professionals, particularly nurses. Exposure to psychiatric training, enhanced mental health literacy, and personal contact with mental illness appear to mitigate stigma. Integrating structured anti-stigma education and contact-based learning into healthcare training programs may promote more compassionate and inclusive mental healthcare delivery.
Community Attitudes toward the Mentally Ill (CAMI)
Copyright (c) 2026 Rajesh Shrestha, Nayeema Shakur, Ritu Meena, Sonal Garg (Author) https://creativecommons.org/licenses/by/4.0
Beyond Household Allocation: Reimagining the Family Adoption Programme for Rural and Hilly India
The transition to Competency-Based Medical Education (CBME) in India marked a paradigm shift in undergraduate medical training, emphasizing community orientation, patient-centered learning, and social accountability. Among its most innovative components is the Family Adoption Programme (FAP), introduced by the National Medical Commission (NMC) to provide medical students with sustained engagement with families and communities from the earliest stages of their training. The programme seeks to bridge the longstanding gap between classroom teaching and real-world public health practice by enabling students to understand the social determinants of health, disease patterns, healthcare-seeking behaviour, and barriers to healthcare access within community settings.
Copyright (c) 2026 Yashpal Sharma, Richa Mahajan (Author) https://creativecommons.org/licenses/by/4.0
Comparative Study of Cardiovascular Reactivity to Cold Pressor Test in Smokers vs Non-Smokers
Received: 05-06-2026 Revised: 10-06-2026 Accepted: 18-06-2026 Introduction: Cigarette smoking is associated with autonomic dysregulation, endothelial dysfunction, and increased cardiovascular risk. The cold pressor test (CPT) is a validated method for assessing sympathetic cardiovascular reactivity. This study compared cardiovascular responses to CPT between smokers and non-smokers and evaluated post-stimulus recovery patterns. Methods: A comparative cross-sectional study was conducted among 60 apparently healthy male participants aged 18–35 years, including 30 smokers and 30 non-smokers. Baseline heart rate (HR), systolic blood pressure (SBP), and diastolic blood pressure (DBP) were recorded. Participants underwent CPT by immersing the non-dominant hand in ice water (4–6°C) for one minute. Peak cardiovascular responses and recovery parameters at 1 and 3 minutes post-test were assessed. Data were analyzed using Student’s t-test and Pearson correlation analysis. Results: Baseline demographic and cardiovascular characteristics were comparable between groups. Following CPT, smokers demonstrated significantly greater cardiovascular reactivity than non-smokers, with higher increases in HR (13.9±4.5 vs. 8.8±3.6 beats/min), SBP (21.3±5.8 vs. 15.4±4.9 mmHg), and DBP (14.6±4.7 vs. 9.8±3.9 mmHg) (all p<0.001). Smokers also exhibited significantly higher HR and blood pressure values during the recovery phase, indicating delayed autonomic recovery. Smoking duration showed a positive correlation with SBP reactivity (r=0.42, p=0.021) and HR response (r=0.37, p=0.039). Conclusion: Smokers exhibit exaggerated cardiovascular responses and delayed recovery following cold pressor stimulation, suggesting enhanced sympathetic activity and impaired autonomic regulation. These findings indicate early subclinical cardiovascular dysfunction in apparently healthy smokers and underscore the importance of smoking cessation for cardiovascular risk reduction.
Copyright (c) 2026 Grishma Shrestha, Mrinal Sharma, Megha Kapoor, Adi Abbass (Author) https://creativecommons.org/licenses/by/4.0
Medic-legal Documentation in Hospitals : Impact on Forensic Evaluation and Legal Outcomes in the Indian context
Received: 11-03-2026 Revised: 23-03-2026 Accepted: 28-03-2026 Medico-legal documentation represents a crucial interface between clinical practice and the legal system, particularly in hospital settings where physicians frequently encounter medico-legal cases such as assaults, road traffic injuries, burns, poisoning, and sexual offences. Accurate documentation of clinical findings in such cases is essential for forensic evaluation and often constitutes primary documentary evidence used in criminal and civil courts. In the Indian healthcare system, medical practitioners are legally obligated to maintain comprehensive medical records and medico-legal reports in accordance with professional regulations, statutory provisions, and judicial expectations. This review examines the principles, regulatory framework, and practical significance of medico-legal documentation in hospitals and explores its impact on forensic interpretation and legal outcomes within the Indian context. A narrative review of relevant literature was conducted using academic databases including PubMed and Google Scholar, along with government guidelines and judicial decisions pertaining to medical documentation. The findings indicate that medico-legal documentation requires systematic recording of patient identification, incident history, detailed injury description, clinical findings, investigations, and medical opinion. Proper documentation assists forensic experts in reconstructing events, determining mechanisms of injury, and classifying injuries according to legal provisions. However, multiple studies have reported deficiencies in medico-legal documentation practices, including incomplete injury descriptions, missing examination times, illegible handwriting, and absence of physician identification details, which may weaken the evidentiary value of medical reports in courts of law. Strengthening medico-legal documentation practices through standardized documentation formats, improved clinician training, regular medico-legal audits, and adoption of digital medico-legal reporting systems is essential for enhancing the reliability of medical evidence and ensuring fair judicial outcomes. Ultimately, robust medico-legal documentation contributes not only to effective forensic evaluation but also to improved accountability within the healthcare and legal systems.
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0/
Burden and determinants of anemia among tribal women in Jammu and Kashmir: A systematic review and meta-analysis.
Received: 01-03-2026 Revised: 16-03-2026 Accepted: 21-03-2026 Anemia remains a major public health problem affecting women of reproductive age, particularly in low- and middle-income countries. Tribal populations are among the most vulnerable groups due to socioeconomic disadvantage, limited healthcare access, and poor nutritional status. In the Union Territory of Jammu and Kashmir, tribal communities such as the Gujjar and Bakarwal inhabit geographically remote regions where health services and nutritional resources may be limited. Although several individual studies have reported anemia among tribal women in this region, the overall burden and associated determinants have not been systematically synthesized. The present systematic review and meta-analysis aimed to estimate the pooled prevalence of anemia and identify key determinants among tribal women in Jammu and Kashmir. A comprehensive literature search was conducted across major electronic databases including PubMed/MEDLINE, Scopus, Web of Science, Embase, and Google Scholar for studies published up to Decmeber 2025. Observational studies reporting anemia prevalence or determinants among tribal women were included. Fourteen studies met the eligibility criteria and were included in the qualitative synthesis, while twelve studies provided sufficient data for meta-analysis. The pooled prevalence of anemia among tribal women was estimated to be 54.8% (95% CI: 47.2%–62.3%), indicating a substantial burden in this population. Poor dietary intake, low socioeconomic status, limited access to healthcare services, inadequate antenatal care utilization, and high parity were the most frequently reported determinants. The findings highlight a considerable burden of anemia among tribal women in Jammu and Kashmir and emphasize the need for targeted public health interventions focusing on nutritional improvement, maternal healthcare services, and improved accessibility of healthcare in remote tribal areas.
Copyright (c) 2026 Anuj Kapoor, Aditi Kantipuly, Neha Choudhary (Author) https://creativecommons.org/licenses/by/4.0/
Assessment of Knowledge, Attitude, and Practice (KAP) Regarding Antimicrobial Stewardship Among Resident Doctors in a Tertiary Care Teaching Hospital
Received: 04-03-2026 Revised: 19-03-2026 Accepted: 27-03-2026 Background: Antimicrobial resistance (AMR) represents a major global health challenge, driven largely by inappropriate antimicrobial use. Antimicrobial stewardship programs (ASPs) aim to optimize antibiotic prescribing; however, their effectiveness depends significantly on the knowledge, attitude, and practices (KAP) of frontline prescribers, particularly resident doctors. Methods: A cross-sectional, questionnaire-based study was conducted at a tertiary care teaching institution in North India over six months. A structured, validated Google Forms proforma was used to assess KAP related to antimicrobial stewardship among resident doctors. A total of 1500 residents participated. Data were analyzed using descriptive and inferential statistics, with p < 0.05 considered statistically significant. Results: Among participants, 48% demonstrated good knowledge, while 78% exhibited a positive attitude toward antimicrobial stewardship. Awareness of AMR was high (92%), but familiarity with WHO AWaRe classification was limited (44%). Appropriate prescribing practices were observed in only 44% of residents. Senior residents had significantly better knowledge compared to junior residents (p < 0.001). A notable gap between knowledge and practice was identified. Conclusion: Despite adequate awareness and favorable attitudes, substantial deficiencies in stewardship-related knowledge and prescribing practices persist among resident doctors. Structured training programs and strengthened institutional stewardship measures are essential to improve rational antimicrobial use and bridge the knowledge–practice gap.
Histopathological Patterns of Glomerulonephritis in Renal Biopsies: A 5-Year Retrospective Study
Received: 23-01-2025 Revised: 16-02-2026 Accepted: 28-02-2026 Introduction: Glomerulonephritis (GN) is a major cause of chronic kidney disease worldwide, with marked geographic variability in histopathological patterns. Periodic regional evaluation of biopsy-proven GN is essential to understand epidemiologic trends and optimize management strategies. Methods: This retrospective observational study included all native renal biopsies performed between January 2020 and December 2024 at a tertiary care center. Biopsies demonstrating glomerulonephritis were analyzed. Clinical data, laboratory parameters, and histopathological findings from light microscopy, immunofluorescence, and electron microscopy (where indicated) were reviewed. GN was classified into primary and secondary categories. Statistical analysis was performed using appropriate tests, with p < 0.05 considered significant. Results: Of 312 native renal biopsies, 268 (85.9%) were diagnosed as GN. The mean age was 36.8 ± 14.7 years, with male predominance (60.4%). Nephrotic syndrome was the most common presentation (50.0%). Primary GN accounted for 64.9% of cases, while secondary GN comprised 35.1%. IgA nephropathy (19.4%) was the most frequent diagnosis, followed by focal segmental glomerulosclerosis (17.2%) and membranous nephropathy (14.2%). Lupus nephritis (15.3%) was the leading secondary cause. Rapidly progressive renal failure was strongly associated with pauci-immune crescentic GN and proliferative lupus nephritis (p < 0.001). Crescent formation was observed in 21.6% of cases and moderate-to-severe interstitial fibrosis and tubular atrophy correlated with elevated serum creatinine (p = 0.003). An increasing trend in focal segmental glomerulosclerosis was noted over the study period. Conclusion: IgA nephropathy and focal segmental glomerulosclerosis predominate among primary GN, whereas lupus nephritis remains the leading secondary cause. Continuous regional surveillance is necessary to monitor evolving trends and guide evidence-based nephrology practice.
Comparative Histomorphometric Analysis of Hepatocyte Nuclear Morphometry and Binucleation in Young and Elderly Adult Cadavers: A Pilot Study
Received: 31-12-2025 Revised: 29-01-2026 Accepted: 07-02-2026 Background: Aging of the liver is accompanied by subtle structural alterations at the cellular level, including changes in hepatocyte nuclear morphology and the frequency of binucleated cells. Quantitative human data describing these changes remain limited, particularly in cadaveric studies employing objective morphometric techniques. Methods: A comparative cross-sectional histomorphometric study was conducted on liver tissue obtained from 16 adult cadavers. Specimens were categorized into two age groups: young adults (20–40 years, n = 8) and elderly adults (≥60 years, n = 8). Standardized wedge biopsies were obtained from the right hepatic lobe, processed using routine histological techniques, and stained with hematoxylin and eosin. Digital histomorphometry was used to measure hepatocyte nuclear diameter, nuclear area, cytoplasmic area, nuclear-to-cytoplasmic (N:C) ratio, and the percentage of binucleated hepatocytes. Statistical comparisons between groups were performed using appropriate parametric or nonparametric tests, with significance set at p < 0.05. Results: Elderly specimens demonstrated significantly greater nuclear diameter and nuclear area compared with young adults (p < 0.001). The N:C ratio was also significantly higher in the elderly group. In addition, the proportion of binucleated hepatocytes showed a marked increase in elderly cadavers, exceeding twofold relative to younger specimens (p < 0.001). Age exhibited strong positive correlations with nuclear morphometric parameters and binucleation frequency. Conclusion: Hepatic aging is associated with measurable enlargement of hepatocyte nuclei and increased binucleation, reflecting structural remodeling of liver parenchyma. Despite the modest sample size, the consistent morphometric trends observed highlight the utility of quantitative histological analysis in characterizing physiological hepatic aging.
Primary Health Care and Community-Based Approaches as the Foundation for Universal Health Coverage in India
Universal Health Coverage (UHC) is best understood not as an insurance entitlement, but as a systemic guarantee that all individuals receive promotive, preventive, curative, rehabilitative, and palliative services of adequate quality without financial hardship. In India, where demographic diversity intersects with epidemiological transition and federal governance complexity, the pathway to UHC must be structurally anchored in primary health care (PHC) and community-based delivery models. Hospital expansion and insurance penetration, while necessary, are insufficient substitutes for a resilient primary care architecture.
Sudden Death Following Ingestion of an Unlabeled Sexual-Enhancement Capsule: A Forensic Autopsy Case Report
Received: 22-10-2025 Revised: 18-11-2025 Accepted: 03-12-2025 A 28-year-old male was found dead and brought to the emergency department of Guru Nanak Dev Hospital, Amritsar, after being discovered unconscious in a hotel room where he had checked in with a female sex worker. The accompanying witness reported that the decedent ingested an unlabeled capsule claimed to be a sexual-performance enhancer and collapsed prior to any intercourse. Autopsy conducted at Government Medical College Amritsar demonstrated bluish discoloration of the lips, nail beds, and earlobe regions, marked visceral congestion, and deep gastric mucosal congestion with undigested food. Histopathology showed no intrinsic pathology. Toxicological screening was negative for routine poisons. Cause of death was certified as undetermined, with a possibility of unknown poisoning. This case highlights the increasing abuse of unregulated sexual-enhancement agents in Punjab, a region marked by high prevalence of synthetic-drug use. It brings to fore the need for expanding toxicology panels, increased public–patient education, and preventive strategies directed at extreme sexual-pleasure behavior.
Neuroimaging and Clinical Course of Methanol-Induced Encephalopathy: Insights from a Recent Mass-Poisoning Event
Received: 11-10-2025 Revised: 13-12-2025 Accepted: 21-12-2025 Methanol poisoning remains a significant public-health concern, especially in regions where restrictive alcohol policies foster illicit and unregulated alcohol production. The Kuwait methanol outbreak of August 2025 resulted in numerous fatalities and neurological injuries. This case report describes a survivor who initially received dialysis in Kuwait but returned to India several days later with persistent cognitive dysfunction. At presentation, he exhibited slowed mentation but had remarkably good visual recovery. MRI revealed classical features of methanol-induced neurotoxicity, including bilateral putaminal hyperintensities and deep white matter involvement. The patient was managed at the Department of Neurology, Fortis Hospital, Jalandhar. Although fomepizole was not administered during the initial Kuwait-based treatment, supportive care and neuro-rehabilitation resulted in gradual cognitive improvement. He was eventually discharged in stable condition with only minor residual neural complications. This case highlights the characteristic imaging findings of methanol toxicity, demonstrates the potential for partial neurological recovery even after delayed presentation, and emphasizes the need for improved regulatory and clinical preparedness to mitigate the consequences of toxic alcohol outbreaks.
Health Burden of Ambient Air Pollution on Respiratory Diseases in the Delhi–National Capital Region (2010–2025): A Systematic Review and Meta-analysis
Received: 21-11-2025 Revised: 29-11-2025 Accepted: 07-12-2025 Introduction: Ambient air pollution is a major contributor to respiratory morbidity and mortality globally, with disproportionate impacts in low- and middle-income countries. The Delhi–National Capital Region (NCR) experiences persistently high levels of air pollution, yet region-specific quantitative syntheses of respiratory health impacts remain limited. This study aimed to systematically review and meta-analyse epidemiological evidence on the association between ambient air pollution and respiratory outcomes in Delhi–NCR from 2010 to 2025. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. PubMed/MEDLINE, Scopus, Web of Science, Embase, and additional sources were searched for eligible studies examining associations between ambient air pollutants (PM₂.₅, PM₁₀, NO₂, SO₂, O₃, CO) and respiratory morbidity or mortality in Delhi–NCR. Time-series, case-crossover, cohort, and observational studies reporting quantitative effect estimates were included. Random-effects meta-analyses were performed to derive pooled relative risks per 10 µg/m³ increase in pollutant concentration. Risk of bias was assessed using adapted ROBINS-E and Newcastle–Ottawa tools. Results: Ten studies met inclusion criteria for qualitative synthesis, and seven were included in meta-analysis. Short-term increases in PM₂.₅ were associated with higher respiratory emergency visits (RR 1.038; 95% CI: 1.021–1.056) and respiratory mortality (RR 1.019; 95% CI: 1.006–1.033). PM₁₀ exposure was linked to increased respiratory admissions (RR 1.026; 95% CI: 1.012–1.041), while NO₂ showed a strong association with acute respiratory visits (RR 1.041; 95% CI: 1.018–1.064). Heterogeneity ranged from low to moderate. Conclusion: Ambient air pollution is consistently associated with increased respiratory morbidity and mortality in Delhi–NCR. These findings underscore the urgent need for strengthened air quality interventions and targeted public health strategies in highly polluted urban settings.
Interplay of Cardiac and Renal Dysfunction with Disease Severity in Cirrhosis: A Prospective Cross-Sectional Study
Received: 03-10-2025 Revised: 25-10-2025 Accepted: 03-11-2025 Introduction: Cirrhosis is a multisystem disorder characterized by hepatic fibrosis, portal hypertension, and progressive extrahepatic organ involvement. Cardiac dysfunction and renal impairment significantly influence prognosis but remain under-characterized in North Indian populations. This study evaluated the etiological spectrum of cirrhosis and assessed the prevalence and interrelationship of cardiac and renal dysfunction across disease severity. Methods: A prospective cross-sectional study was conducted at a tertiary care centre in Amritsar (October 2023–January 2025). Eighty clinically and radiologically confirmed cirrhotic patients were enrolled. Clinical examination, biochemical evaluation, viral screening, Doppler ultrasonography, ECG, and transthoracic echocardiography were performed. Disease severity was classified by Child–Pugh criteria. Renal dysfunction was assessed using estimated glomerular filtration rate (eGFR). Statistical analyses were performed using SPSS v21 with significance set at p≤0.05. Results: Alcoholic liver disease was the leading etiology (45%), followed by hepatitis B (25.8%) and NAFLD (17.5%). Half of the cohort belonged to Child–Pugh class B. Diastolic dysfunction was detected in 56.9% of patients, most commonly Grade I. Renal impairment (eGFR <60 mL/min/1.73m²) was present in 19.3%. Both cardiac and renal dysfunctions showed increasing prevalence with advancing Child–Pugh class. A significant association was observed between reduced left ventricular ejection fraction and lower eGFR values (p=0.017), indicating interdependence of cardiac and renal compromise. Conclusion: Cirrhosis in this population is predominantly alcohol-related, with substantial cardiac and renal involvement that intensifies with disease severity. Integrated evaluation of cardio-renal function is essential for prognostication and timely management. Larger multicentre longitudinal studies are warranted to refine risk stratification.
Disorders of Electrolytes and Acid-Base Homeostasis as Precursors to Chronic Kidney Disease: A Phenotypic Clustering Study in a Rural Indian Population
Received: 03-10-2025 Revised: 25-10-2025 Accepted: 03-11-2025 Background: Imbalances in electrolytes and acid-base status are recognized early indicators of renal impairment, a relationship of critical importance in low-resource rural communities. This investigation assesses key serum parameters, a derived Electrolyte Ratio Index (ERI), and patient categorization via clustering methods within a rural Indian demographic. Methods: A total of 200 adults were enrolled in this cross-sectional analysis. Concentrations of serum electrolytes, uric acid, calcium, and creatinine were quantified, with the estimated glomerular filtration rate (eGFR) derived. Analyses were performed on a Vitros 4600 platform. The Electrolyte Ratio Index was computed as (Na⁺ + K⁺ + Cl⁻)/HCO₃⁻. Statistical evaluation employed Pearson correlation, sensitivity-specificity assessment, and k-means clustering. Results: Commonly observed disturbances included hyponatremia (14.0%), hyperkalaemia (17.5%), reduced bicarbonate (15.0%), and hyperuricemia (22.0%). Bicarbonate concentration demonstrated a significant inverse correlation with serum creatinine (r = -0.47, p < 0.001). An ERI value of ≥15 was associated with a diminished mean eGFR (54.7 ml/min), exhibiting a sensitivity of 60%, specificity of 90%, and a Youden Index of 0.50. Cluster analysis delineated three unique biochemical phenotypes, one of which represented a high-risk renal profile. Conclusion: Electrolyte and acid-base derangements show a strong association with declining renal function. The ERI and cluster-based phenotyping present viable, economical strategies for the early stratification of chronic kidney disease risk in settings with limited healthcare resources.
Social Determinants of Health, Conflict and Displacement: Health System Responses and Continuity of Care
Armed conflict and forced displacement are not only humanitarian crises, but they are profound public health emergencies shaped by, and in turn reshaping the social determinants of health. Poverty, disrupted education, food insecurity, unsafe housing, gender inequities, and weakened governance interact powerfully with violence to erode health outcomes across generations. As conflicts become increasingly protracted and urban, and displacement more prolonged, the central challenge for health systems is no longer limited to emergency trauma care. It is the preservation of continuity of care and equity in access amid instability, mobility, and social fragmentation.
Workplace Violence Against Healthcare Providers: Medico-Legal Perspectives, Administrative Challenges, and Policy Solutions in South Asia
Received: 28-08-2025 Revised: 03-09-2025 Accepted: 13-09-2025 Workplace violence against healthcare providers is an escalating global crisis with profound medico-legal, ethical, and administrative implications. South Asia is disproportionately affected, with overcrowded facilities, fragile health systems, high patient expectations, and socio-political tensions driving incidents that range from verbal abuse to mob assaults. Consequences include psychological trauma, compromised patient care, attrition of skilled professionals, and erosion of trust in healthcare institutions. Medico-legal documentation remains inadequate, limiting judicial accountability and epidemiological insight. Hospital administrators face escalating challenges in ensuring provider safety while balancing patient rights and continuity of care. Comparative models from high-income countries demonstrate the effectiveness of integrated frameworks that combine legislation, zero-tolerance policies, institutional preparedness, and public awareness. This review synthesizes epidemiological trends, medico-legal dimensions, administrative challenges, and policy solutions for workplace violence in South Asia, situating the issue within a global framework. Recommendations emphasize the need for harmonized legislation, strengthened medico-legal protocols, hospital-level security reforms, conflict resolution training, and community engagement. By addressing structural, legal, and ethical gaps, South Asia can advance toward safer healthcare environments and align with international standards of occupational health and justice.
Analysis of the Medical Termination of Pregnancy (MTP) Act 2021: Indian Law, Amendments, and the Rights of the Unborn
Received: 28-08-2025 Revised: 03-09-2025 Accepted: 13-09-2025 The Medical Termination of Pregnancy (MTP) Act, first enacted in 1971, marked a pivotal moment in Indian reproductive health legislation by legalizing abortion under defined circumstances to reduce unsafe practices. The 2021 amendment sought to expand access, raising the upper gestational limit from 20 to 24 weeks for specific vulnerable categories of women, recognizing the reproductive autonomy of unmarried women, and eliminating spousal consent requirements. Despite these advances, recent judicial interpretations, particularly the Supreme Court’s 2024 refusal to permit termination of a 30-week pregnancy, underscore the ongoing tension between reproductive rights and the rights of the unborn. This review critically examines the historical evolution, amendments, and current provisions of the MTP Act in light of global legal frameworks. It highlights persisting lacunae, including inadequate recognition of mental health grounds, bureaucratic hurdles in late-term abortions, definitional ambiguities regarding fetal abnormalities, and limited public awareness. Comparative insights from jurisdictions such as the United States, United Kingdom, France, and Germany illustrate diverse approaches to balancing women’s autonomy and fetal viability. The analysis concludes that while the MTP Amendment 2021 represents progressive reform, further refinements are essential to ensure reproductive justice. Policy recommendations include recognizing psychological distress as a valid ground beyond 24 weeks, streamlining Medical Board procedures, enhancing public awareness, and harmonizing Indian law with international best practices. By situating the Indian experience within a broader ethical and legal discourse, this review underscores the need for a more nuanced, rights-based approach to abortion regulation.
Copyright (c) 2026 Khushpreet Kaur, Sunny Basra, Nishu Dihana (Author) https://creativecommons.org/licenses/by/4.0/
EVALUATING YOGIC BREATHING INTERVENTIONS ON LUNG ENDURANCE IN YOUNG ADULT SMOKERS
Received: 23-08-2025 Revised: 01-09-2025 Accepted: 10-09-2025 Introduction: Cigarette smoking, a leading global cause of preventable mortality, induces subclinical respiratory damage long before symptoms manifest. Yogic practices like Pranayama and Om chanting are posited to improve respiratory function and resilience. This study investigates the efficacy of an 8-week intervention combining Alternate Nostril Breathing (ANB) and Om chanting on enhancing respiratory endurance and pulmonary function in asymptomatic young adult smokers. The study was conducted to evaluate the effects of a combined ANB and Om chanting intervention on parameters of respiratory endurance (BHTi, BHTe, 40 mmHg test) and Spirometric lung function (FEV1, FVC, FEF25-75%) in asymptomatic smokers. Materials and Methods: A total of 100 asymptomatic smokers (aged 18-25 years) participated in this 8-week interventional study. Pre- and post-intervention assessments included anthropometric data, respiratory endurance tests, and spirometry. Participants underwent supervised sessions of ANB and Om chanting for 10 minutes daily, 6 days a week. Data were analyzed using descriptive statistics and a paired t-test. Results: The cohort's mean age was 21.4 ± 2.1 years, and mean BMI was 22.6 ± 1.8 kg/m². Post-intervention, all parameters showed a highly significant improvement (p < 0.001). Respiratory endurance parameters (BHTi, BHTe, 40mmHg test) increased by 36.4%, 34.1%, and 44.6% respectively. Spirometric parameters also demonstrated significant enhancement, with FEV1 increasing from 3.21 ± 0.42 L to 3.45 ± 0.38 L (p < 0.001) and FEF25-75% from 3.85 ± 0.51 L/s to 4.12 ± 0.47 L/s (p < 0.001). Conclusion: An 8-week regimen of Alternate Nostril Breathing and Om chanting significantly improves respiratory muscle endurance and pulmonary function in asymptomatic young adult smokers. These yogic techniques are effective complementary strategies to mitigate smoking-induced respiratory decline.
Comparative Efficacy and Safety of Daily Versus Alternate Day Dosing of Rosuvastatin in Dyslipidemic Patients: A Prospective, Randomized, Open Label Study
Received: 28-08-2025 Revised: 03-09-2025 Accepted: 13-09-2025 Background: Dyslipidemia is a major modifiable risk factor for atherosclerotic cardiovascular disease, and statins remain the cornerstone of therapy. Rosuvastatin is highly potent, but concerns regarding adverse effects and adherence have prompted evaluation of alternate dosing strategies. Objective: To compare the efficacy and safety of daily versus alternate-day dosing of rosuvastatin in dyslipidemic patients. Methods: In this prospective, randomized, open-label, parallel-group study, 90 patients with dyslipidemia were randomized into three groups: Group A (rosuvastatin 10 mg daily), Group B (rosuvastatin 10 mg administered alternately), and Group C (rosuvastatin 20 mg administered alternately). Patients were followed for 12 weeks with serial evaluation of lipid profile, glycemic parameters, and adverse events. Results: All regimens significantly reduced total cholesterol, LDL-C, and triglycerides (p < 0.001), with no statistically significant differences between groups. LDL-C reduction approached 42% across all arms. HDL-C showed a modest, non-significant increase. HbA1c rose slightly but remained clinically insignificant; fasting blood sugar did not change meaningfully. Adverse events, mainly myalgia and headache, were more frequent with daily dosing, while alternate-day regimens were better tolerated. No serious adverse events occurred. Conclusion: Alternate-day dosing of rosuvastatin provides lipid-lowering efficacy comparable to daily dosing, with fewer adverse events and potential cost savings. This regimen offers a safe and effective alternative for long-term dyslipidemia management in Indian patients. Larger and longer-term studies are needed to validate cardiovascular outcome benefits.
MATERNAL OUTCOME IN ADVANCED MATERNAL AGE (>35Yrs) - A PROSPECTIVE CASE CONTROL STUDY
Received: 28-08-2025 Revised: 03-09-2025 Accepted: 13-09-2025 Background: Advanced maternal age (AMA), defined as pregnancy at ≥35 years, is increasingly prevalent and has been associated with adverse maternal and perinatal outcomes. This study aimed to evaluate maternal outcomes in AMA women compared with younger mothers. Methods: A prospective case–control study was conducted in the Department of Obstetrics and Gynaecology, Kalpana Chawla Government Medical College, Karnal, over 18 months. A total of 80 antenatal women beyond 28 weeks of gestation were enrolled and divided into two groups: Group I (n=40, ≥35 years) and Group II (n=40, 20–34 years). Maternal outcomes assessed included hypertensive disorders, gestational diabetes mellitus (GDM), antepartum haemorrhage, preterm premature rupture of membranes (PPROM), and mode of delivery. Statistical analysis was performed using SPSS v25, with p<0.05 considered significant. Results: Women in the AMA group were significantly older (mean 37.6 vs. 26.0 years, p<0.001) and predominantly multiparous (82.5% vs. 30.0%, p<0.001). Overweight and obesity were more frequent among AMA women, though not statistically significant. The frequency of maternal complications was higher in the AMA group, with GDM (22.5% vs. 7.5%) and hypertensive disorders (17.5% vs. 5.0%) showing a notable trend, though differences were not statistically significant. Preterm labour (20% vs. 22.5%) and PPROM (10% vs. 7.5%) were comparable. Mean gestational age at delivery was similar in both groups (37.2 vs. 37.3 weeks). Conclusion: AMA is associated with increased risks of GDM, hypertensive disorders, and preterm complications, underscoring the importance of targeted antenatal surveillance and individualized care strategies for optimizing maternal outcomes.
Adult vaccination in India: A neglected health concern
Adult vaccination has received considerable attention in North American and European countries, but the focus still remains quite low in India. Immunisation holds immense public health importance. Our country has given considerable attention to childhood vaccination, thereby reducing the burden of Vaccine-Preventable Diseases (VPDs) to a large extent. But adult vaccination also needs to be prioritised, as it can reduce the healthcare cost substantially. A large proportion of the Indian population is exposed to risk factors for infectious diseases like overcrowding, poor diet, low access to quality healthcare and inadequate sanitation. Older adults, especially those with an immunocompromised state, are at a higher risk. However, the impact of VPDs on India’s adult demographic remains underestimated largely due to the limited surveillance of VPDs among adults. The 2017–2018 estimates from nationally representative data for individuals aged 60 years and above indicate a considerably low vaccination coverage. For instance, pneumococcal vaccine coverage stands at 0.74%, while the highest uptake is observed for diphtheria and tetanus vaccines at only 2.75%. While most international health agencies have long endorsed paediatric immunisation against VPDs, the prioritisation of adult immunisation has lagged, especially in low- and middle-income countries (LMICs).