Dissertations

Prevalence of vitamin b12 deficiency in elderly with diabetes mellitus on metformin therapy and its association with cognition level

2026-08-20T15:16:38Z

Prevalence of vitamin b12 deficiency in elderly with diabetes mellitus on metformin therapy and its association with cognition level Kushal Bhangale Introduction: Vitamin B12 is indispensable for hematopoiesis and neurologic function. Metformin, the drug of choice for T2DM, has been noted to cause abnormal vitamin B12 absorption with prolonged therapy. Older patients are especially vulnerable because of age‐ related gastrointestinal changes and concomitant nutritional deficits. Aim: To assess the frequency of vitamin B12 deficiency among older patients with Type 2 diabetes who have been on metformin for a minimum of three years and assess its association with cognitive performance. Methods: In an 18-month, observational, cross-sectional study at our tertiary care hospital, 75 patients aged ≥60 years on metformin therapy (≥3 years) were enrolled. Patients with confounding conditions (e.g. pernicious anemia, gastrointestinal surgeries/disorders, chronic alcohol use, altered renal/hepatic function, or on proton pump inhibitors) were excluded. A structured questionnaire collected demographic data, metformin dose/duration, comorbidities, dietary patterns, and smoking status. A thorough clinical evaluation focused on neuropathic symptoms. Venous blood was drawn for serum vitamin B12 (categorized as deficient: <200 pg/mL, borderline: 200–400 pg/mL, or adequate: >400 pg/mL), blood sugar parameters, HbA1c, and other routine tests. Patients with vitamin B12 deficiency underwent cognitive evaluation using the Montreal Cognitive Assessment (MoCA). Statistical comparisons and multivariate logistic regression were performed using IBM SPSS version 30.0 with significance set at p < 0.05. Results: Overall, 21.3% (16/75) were vitamin B12 deficient. Only 2 patients on metformin for <5 years were deficient compared with 11 of 13 (84.6%) on therapy for >10 years. Deficient patients had a significantly lower mean MoCA scores (22 ± 3). Our result indicates that there is no statistically significant association between dietary habits (vegetarian vs. non-vegetarian) and Vitamin B12 levels in the cases with vitamin b12 deficient states. Conclusion: Elderly with type 2 diabetes mellitus who have been on long-term metformin treatment face a considerable risk of vitamin B12 deficiency, a condition that is closely linked to peripheral neuropathy and could also play a role in cognitive decline. Routine screening and early intervention in this high-risk population are recommended.

A comparative study between transumbilical laparoscopic assisted appendicectomy vs conventional 3 ports laparoscopic appendicectomy

2026-08-20T15:04:52Z

A comparative study between transumbilical laparoscopic assisted appendicectomy vs conventional 3 ports laparoscopic appendicectomy Satvik S Phutane The abdomen is frequently termed a "Pandora's box" because of the multitude of organ systems and anatomical features it encompasses. Consequently, abdominal disorders frequently generate considerable clinical interest. A comprehensive assessment of the abdomen is an invaluable diagnostic instrument, especially for surgeons, as it facilitates the identification of the optimal treatment strategy. Acute appendicitis is the predominant cause of "acute abdomen" in paediatric patients, and the signs and symptoms thereof have become a central focus in clinical teaching. Acute appendicitis is a highly prevalent acute surgical condition impacting the abdomen . A little over seven percent of individuals are likely to get appendicitis at some stage in their lives. Although it can manifest at any age, it is predominantly noted in persons around their twenties and thirties. Despite innovations in technology, the diagnosis of appendicitis still mostly relies on the patient's history and physical examination. Rapid identification and quick surgical referral can mitigate the risk of perforation and avert repercussions. The rate of death for non-perforated appendicitis remains below 1%, although it may escalate to 5% or more in young and older individuals, when delayed diagnosis elevates the risk of perforation. Recognition of acute appendicitis is especially difficult in young women, children, and the elderly, despite advancements in medical care and the application of ultrasonography. Diagnostic scoring systems are valuable and straight forward instruments that facilitate decision- making.6 Prolonged diagnostic delays might result in problems, elevating morbidity, whilst excessively conservative diagnoses may lead to unwarranted appendectomies.

Study on evaluation of safety and efficacy of leucocyte platelet rich fibrin (l-prf) versus conventional dressing for the treatment of chronic cutaneous ulcers

2026-08-20T14:58:18Z

Study on evaluation of safety and efficacy of leucocyte platelet rich fibrin (l-prf) versus conventional dressing for the treatment of chronic cutaneous ulcers Rangavajjula D.S. Vyshnavi Harika Introduction: Chronic cutaneous ulcers represent a significant healthcare challenge, affecting approximately 1-2% of the global population and contributing substantially to morbidity and healthcare costs. Conventional wound management strategies often yield suboptimal outcomes, necessitating the exploration of advanced therapeutic approaches. Leucocyte-Platelet Rich Fibrin (L-PRF), an autologous blood-derived biomaterial rich in platelets, leukocytes, and growth factors embedded within a fibrin matrix, has emerged as a promising regenerative medicine strategy for tissue repair. This study aimed to evaluate the efficacy and safety of L-PRF compared to conventional dressings in the management of chronic cutaneous ulcers. Methods: This prospective, randomized controlled trial enrolled 112 patients with chronic cutaneous ulcers of various etiologies, who were randomly allocated to receive either L-PRF (n=56) or conventional dressings (n=56). L-PRF was prepared from autologous blood and applied weekly to the ulcer bed in the intervention group, while the control group received standard saline-soaked gauze dressings. Outcome measures included ulcer size reduction, granulation tissue quality, pain scores, healing rates, time to complete healing, and adverse events, assessed over a 4-week follow-up period. Results: Demographic characteristics and baseline ulcer parameters were comparable between groups. The L-PRF group demonstrated significantly greater ulcer size reduction at 2 weeks (p=0.02) and 4 weeks (p<0.001), superior granulation tissue quality (p<0.001), and lower pain scores (p<0.001) compared to the conventional dressing group. Most notably, 100% of ulcers in the L-PRF group achieved complete healing versus 26.8% in the conventional group (p<0.001), with a significantly shorter healing time (4.25±0.83 vs. 5.4±0.5 weeks, p<0.001). The L-PRF group exhibited a lower incidence of minor infections (5.4% vs. 12.5%), although this difference was not statistically significant (p=0.18). No serious adverse events were reported in either group. Conclusion: L-PRF represents a highly effective regenerative medicine strategy for the treatment of cutaneous ulcers, significantly outperforming conventional dressings in terms of healing rates, healing time, tissue quality, and patient comfort. The autologous nature, minimal preparation requirements, and favorable safety profile of L-PRF enhance its clinical utility and potential for widespread implementation in chronic wound management.

A study on accuracy of “point of care ultrasound” in diagnosing and management of necrotizing fasciitis

2026-08-20T14:51:50Z

A study on accuracy of “point of care ultrasound” in diagnosing and management of necrotizing fasciitis Medikonda Eswar Background: Necrotizing fasciitis (NF) is a rapidly progressive, life- threatening soft tissue infection with high mortality rates. Early diagnosis and prompt surgical intervention are crucial for survival, yet the initial diagnosis remains challenging due to nonspecific early presentations. This study evaluated the diagnostic accuracy of point-of- care ultrasound (POCUS) in identifying NF and its utility in guiding clinical management decisions. Methods: This prospective observational study included 85 patients with suspected NF at a tertiary care center in India from April 2023 to April 2025. Trained emergency physicians performed POCUS examinations using high-frequency linear transducers and low-frequency curvilinear transducers when necessary. Sonographic findings were documented and correlated with surgical observations, clinical outcomes, and laboratory parameters. Primary outcomes included POCUS diagnostic accuracy, need for surgical intervention, and mortality rates. Results: The study population had a mean age of 50.2 years, with male predominance (62.4%) and primarily lower limb involvement (77.6%). POCUS demonstrated high positivity (97.6%) with predominantly fluid collection (77.6%), loss of vascularity (65.9%), and fascial thickening (52.9%). Sensitivity was highest for fascial thickening (97.1%) and fluid collection (92.5%). The majority required multiple debridements (83.5%), with 43.5% undergoing three procedures. At three-week follow-up, 25.9% achieved partial recovery and 18.8% complete recovery, with 15.3% mortality. Complications included amputation (11.8%), sepsis (9.4%), and wound infection (8.2%). POCUS assessment at three weeks showed persistent changes in 36.5% of patients despite clinical improvement in many cases. Conclusion: POCUS is a highly sensitive diagnostic tool for NF with excellent correlation to surgical findings. Its immediate availability, non- Invasive nature and repeatability position it as a valuable adjunct in the initial assessment and monitoring of this life-threatening condition. Integration of POCUS into standard assessment protocols for suspected NF can potentially expedite diagnosis, guide surgical interventions, and improve clinical outcomes.