This study aimed to determine the bacterial profile and their antibiotic spectrum in patients with ventilator-associated pneumonia (VAP) and investigate the risk factors for VAP and the presence of multidrug-resistant (MDR) pathogens.

Tricuspid valve pathology is a relatively common anomaly. In patients with mechanical tricuspid valve replacement, implantation of a permanent pacemaker can be challenging due to the risk of valve damage, failure, and lead fracture associated with right ventricular endocardial leads. Epicardial leads may be an option, but they require a surgical procedure and are not preferred in patients with prior thoracotomy. This case report aims to demonstrate the safety and feasibility of left ventricular (LV) pacing via the coronary sinus (CS) in a 30-year-old young female with a mechanical tricuspid valve and infected epicardial leads. Due to the complications and contraindications of traditional approaches, Lead implantation via the CS was utilized. This method allowed for successful pacemaker implantation, demonstrating the feasibility and safety of LV pacing in such complex cases. The use of CS-guiding catheters and specialized leads facilitated effective cannulation and stable, reliable pacing, avoiding the need for further invasive surgeries.

Pharmacology is one of the most dynamic and evolving branches, not only in the concepts but also in teaching methodologies. Many attempts have been made by various colleges all over the world to make the teaching of pharmacology more interesting and relevant.

Machine learning (ML) has been tried in predicting outcomes following sepsis. This study aims to identify the utility of stacked ensemble algorithm in predicting mortality.

Diabetic peripheral neuropathy (DPN) is a chronic microvascular complication in diabetic mellitus patients due to chronic hyperglycemia, resulting in platelet hyperactivity and dyslipidemia. Alpha-lipoic acid (ALA) is a potent antioxidant which has antiplatelet activity and lipid-modulating characteristics and plays a major role in the prevention of disease progression.

Balantidium coli is the largest, uncommon, and only ciliate parasite that infects humans and is more common in tropics and subtropical regions. It is mostly asymptomatic, but can cause diarrhea and abdominal pain and sometimes leads to perforation of the colon. It is harbored in animals, particularly among pigs in hotter environments and monkeys in the jungles. If not treated on time, it may lead to perforation of the large intestine, peritonitis, appendicle involvement, etc. It is more common in immune-compromised individuals, particularly in those living in poor hygienic conditions. Retrieval of rare parasites was possible only because of prompt stool transport and its early processing. There are only few previous reports regarding the pediatric cases of balantidiasis, and there is a little information about its clinical signs and treatment. Here, we report a case series of B. coli infection presenting as an acute diarrheal disease from Rajasthan.

A 76-year-old male patient, who underwent a post-aortic valve replacement with a mechanical valve in 2006, was on oral anticoagulant therapy with warfarin, maintaining a stable therapeutic level of anticoagulation until 2022. He had a new diagnosis of ulcerative colitis in 2022, following which he was started on mesalamine. He had been having a supratherapeutic level of anticoagulation, as evidenced by an international normalized ratio (INR) of 12 to 14 on multiple occasions since 2022, leading to gastrointestinal bleeding, necessitating multiple packed red cell transfusions. He presented to us in August 2024 with severe anemia due to gastrointestinal bleeding. The evaluation revealed severe depletion of vitamin K-dependent coagulation factors. In this report, we discuss the possible drug-drug interactions between mesalamine and vitamin K antagonists, which went unrecognized leading to life-threatening gastrointestinal bleeding.

Prion diseases are rare, incurable, and rapidly progressive. Pathogenic misfolded proteins accumulate in the central nervous system causing fatal neurodegeneration. Fatal familial insomnia (FFI) is an even rarer, hereditary subset of prion disease. The initial clinical course is nonspecific, leading to difficulties with diagnosis. We describe a patient with a family history of prion disease who presented with early symptoms of FFI including disordered sleep, cognitive dysfunction, and autonomic dysregulation. Notably, diagnostic studies including magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, and electroencephalography (EEG) did not show changes characteristic of prion disease. However, genetic testing showed a pathological, heterozygous mutation c.532G> A (p.Asp178Asn), confirming FFI. His clinical course progressed rapidly, and death occurred several months after the initial hospital presentation. We discuss the pathophysiology and diagnosis of FFI and the emotional care required to treat this fatal disease. General practitioners should be aware of this rare diagnosis to improve patient management.

Effective healthcare leadership is essential to ensure high-quality patient care and foster a supportive work environment for healthcare professionals. This review aims to consolidate existing healthcare leadership literature to provide evidence-based insights that can guide leadership development, improve team performance, and enhance patient care outcomes. A systematic search of academic databases such as PubMed, Scopus, Web of Science, CINAHL, Embase, and Google Scholar was performed using keywords related to healthcare leadership. Studies were selected based on their relevance, peer-reviewed status, and focus on healthcare settings. Thematic analysis was employed to synthesize findings from the selected studies. The review explores various leadership theories, including Great Man, trait, behavioral, transactional, transformational, and contingency theories, highlighting their relevance and application in healthcare. Effective healthcare leaders must possess traits such as vision, emotional intelligence, adaptability, and ethical integrity to navigate the complexities of modern healthcare. The review categorizes different leadership styles, including authoritarian, transformational, transactional, servant, and participative, and discusses their application in specific healthcare contexts. Leaders face challenges such as balancing personal and professional responsibilities, adapting to technological advancements, managing financial constraints, and ensuring regulatory compliance. Healthcare leadership requires a dynamic and adaptable approach that integrates various leadership theories and styles to address the unique challenges of the healthcare environment. This review underscores the importance of leadership development programs and calls for further research to explore the practical implementation of leadership strategies in diverse healthcare settings. The findings provide actionable insights for healthcare leaders to tailor their leadership styles to the specific needs of their teams and organizational contexts, ultimately enhancing patient care and operational efficiency.

Medical research is costly and requires significant effort. While intracellular research hardly follows a formal design, most data-based studies require a structural approach for optimal utilization of resources. Depending on the study's objectives and available resources, as well as the aim to obtain valid and reliable results, the design may be descriptive, employing specific sampling strategies, or analytical, exploring antecedent-outcome relationships. Analytical studies often involve designs such as randomization and blinding in clinical trials, and may use prospective, retrospective, or cross-sectional designs in observational studies. This first article in the series on biostatistics methods specifies the essential features of each design and describes the contexts in which they are most appropriate.

Gender-based violence (GBV), including domestic violence, honor killings, and dowry deaths, represents one of the most extreme forms of violence against women. These deaths are often misclassified as accidents or suicides due to societal biases, leading to underreporting and obscuring the true impact of GBV on women's mortality.

Non-pharmacological distraction using video games (VG) is still under-explored in pediatric surgical patients.

The World Health Organization added methicillin-resistant S aureus (MRSA) to the list of "priority pathogens," given its capacity to cause life-threatening infections. Clindamycin is a preferred treatment for non-complicated S aureus-induced skin and soft tissue infections. Its good tissue penetration and oral absorption make it suitable for outpatient therapy. However, the emergence of inducible and constitutive (MLS B ) resistance led to clinical challenges, primarily due to the potential oversight of inducible resistance in routine antimicrobial sensitivity testing.

This cross-sectional study aimed to investigate the emergence of adeno-enterovirus conjunctivitis, with a focus on its clinical manifestations, prevalence, and implications within the context of acute epidemic conjunctivitis.

Medullary nephrocalcinosis is an uncommon manifestation of primary hyperaldosteronism (PHA) and the exact etiology of this association is still debated. Here we report three cases of PHA with medullary nephrocalcinosis and how medullary nephrocalcinosis in one patient led to misdiagnosis as renal tubular acidosis (RTA). Although PHA and RTA can share overlapping symptoms, careful evaluation of clinical presentation, biochemical tests, and imaging studies are essential to differentiate between the two conditions and ensure appropriate management. Also, awareness of this uncommon manifestation of PHA is essential to avoid misdiagnosis as tubulopathy, as this may delay the treatment.

Neuraxial blockade procedures are essential for anesthesia and pain management but pose risks in patients with uncertain coagulation profiles. Traditional coagulation tests often fail to predict bleeding risks associated with neuraxial blockade. Thromboelastography (TEG) offers real-time insights into coagulation status, potentially improving safety outcomes. In this case series, six patients underwent neuraxial blockade guided by TEG analysis. An individualized anesthetic plan was formulated based on TEG findings to mitigate bleeding risks while ensuring pain management. Tailoring anesthetic techniques to real-time TEG data improved safety outcomes with minimized bleeding complications and satisfactory pain control. In conclusion, neuraxial blockade guided by TEG enhances safety in patients with uncertain coagulation profiles. Further studies are needed to validate benefits in broader clinical settings.

A difficult airway is anticipated with cervical spine injuries (CSIs) as immobilization techniques such as manual in-line stabilization (MILS) are used, which distort the oro-pharyngeal-laryngeal axis. Video laryngoscopes (VLs) make difficult airway management easy, as they do not require axis alignment. The present study aimed to compare the total time taken by Macintosh laryngoscope (ML), conventional blade, and D-blade ™ of C-MAC ® VL in simulated CSI scenarios using MILS.

The "publish and flourish" culture in the biomedical field has led to an increase in the number of publications worldwide, creating pressure on researchers to publish frequently. However, this focus on quantity over quality has resulted in an inflation of the number of authors listed in articles, leading to authorship issues and the rise of fraudulent or predatory scientific and medical journals. To maintain the credibility of scientific research, it is necessary to reform the publication metrics and explore innovative ways of evaluating an author's contributions. Traditional metrics, such as publication counts, fail to capture the research's quality, significance, and impact. As a result, this viewpoint explores and highlights different metrics and novel methods by which an author's productivity and impact can be assessed beyond traditional metrics, such as the H index, i10 index, FWCI, HCP, ALEF, AIF, AAS, JIF, CNA, awards/honors, citation percentile, n-index, and ACI. By using multiple metrics, one can determine the true impact and productivity of an author, and other measures such as awards and honors, research collaborations, research output diversity, and journal impact factors can further aid in serving the purpose. Accurately assessing an author's productivity and impact has significant implications on their academic career, institution, and the broader scientific community. It can also help funding agencies make informed decisions, improve resource allocation, and enhance public trust in scientific research. Therefore, it is crucial to address these issues and continue the ongoing discussion on best method to evaluate and recognize the contributions of authors in today's rapidly changing academic landscape.