Vitamin D deficiency remains a major global public health concern. This study aimed to assess vitamin D levels measured in individuals aged 18 years and older between 2016 and 2025 in a tertiary care hospital and to examine the association of these levels with seasonal, annual, and demographic variables. This retrospective observational study included patients who presented to Duzce University Hospital for any reason between 2016 and 2025 and had serum 25(OH)D levels measured. In total, data from 85,892 individuals were analyzed. Vitamin D status was categorized as sufficient (> 30 ng/mL), insufficient (20-30 ng/mL), or deficient (< 20 ng/mL). Among the participants, 70.2% (n = 60,309) were women and 29.8% (n = 25,583) were men. The mean age was 47.16 ± 17.62 years. The overall mean serum 25(OH)D level was 17.90 ± 12.08 ng/mL. Vitamin D deficiency (< 20 ng/mL) was identified in 68.6% of women and 61.3% of men. Overall, 66.4% (n = 57,051) of participants had Vitamin D deficiency (< 20 ng/mL), 21.7% (n = 18,635) had Vitamin D insufficiency (20-30 ng/mL), and 11.9% (n = 10,206) had sufficient Vitamin D levels (> 30 ng/mL). The mean 25(OH)D level was 19.16 ± 10.74 ng/mL in men and 17.37 ± 12.56 ng/mL in women, with significantly higher levels observed in men (p < 0.001). Participants aged 65 years and older had significantly higher vitamin D levels compared with those under 65 years (p < 0.001). Seasonally, the highest mean vitamin D levels were recorded in summer, whereas the lowest levels were found in winter. Vitamin D deficiency continues to pose a substantial public health challenge in Turkey. Addressing this issue should be considered a priority, and further comprehensive studies are urgently needed to support the development of effective strategies aimed at reducing deficiency rates.

Background: Despite advancements in limb-sparing surgery (LSS), adjuvant therapies, and imaging techniques, amputations remain necessary in certain cases, including locally advanced tumors, inadequate resections, or palliative scenarios. This study aims to provide an overview of tumor-related amputations, comparing primary and secondary amputations in terms of survival, recurrence, and surgical outcomes. Methods: A retrospective cohort study of 132 patients undergoing tumor-related amputations between 2004 and 2023 at a tertiary care center was conducted. Patients were stratified by amputation level (major vs. hand/foot) and timing (primary vs. secondary). Kaplan–Meier survival and multivariate regression analysis identified prognostic factors. Results: Major amputations accounted for 77% of cases, while 23% involved the hands or feet. Primary amputations constituted 55% of procedures, and 45% were secondary interventions. Overall survival was 123 months (95% CI, 105–142), with a 5-year survival rate of 66% and a 10-year survival rate of 53%, respectively. Hand/foot amputations showed superior survival compared to major amputations (p = 0.032). Local recurrence emerged as the only significant predictor of overall survival (p = 0.033). Conclusions: Tumor-related amputations remain crucial in musculoskeletal oncology. Survival outcomes are comparable between primary and secondary amputations, but hand/foot amputations are associated with improved survival. Achieving local control is critical, underscoring the need for precise surgical planning.

Aggression, substance use, and gambling behaviour often co-occur in a larger pattern of dysregulated behaviour. One of the factors that may underlie this phenomenon is impaired inhibitory control. Inhibitory Control Training (ICT) is an alternative intervention being tested for addressing addictive behaviours by targeting inhibitory control. Given the shared underlying mechanisms of these behaviours, applying ICT to aggression represents a possible extension of this intervention. This research will mark the first implementation of a cognitive bias modification approach to managing aggression among patients with co-occurring substance use disorder and gambling behaviour in the Indian context. A secondary aim of this study will be to assess whether changes in aggression and inhibitory control will be associated with reductions in substance use disorder and gambling behaviour. A two-group, parallel randomized controlled trial will be carried out in 130 male in-patients at a tertiary care centre. Participants fulfilling the DSM-5 criteria for substance use disorders, and screening positive for problem (Score ≥ 1) or pathological (Score ≥ 5) gambling on the South Oaks Gambling Screen will be randomly allocated to either experimental (ICT) or control (Sham Training) group. The ICT consists of six 15-min sessions over three days, using a Go/No-Go paradigm with 100% contingency. ST is matched with the active training in terms of both stimulus exposure and response requirements, but reduces the contingency agreement to 50%, thereby preventing the formation of associations between aggressive stimuli and inhibitory responses. Primary and secondary outcome measures will be assessed at baseline, 1-day, 1-month, and 3-months post-intervention. As aggression is frequently observed in individuals with addictive behaviors and is closely linked to deficits in regulatory behaviour, the intervention, if proven efficacious, could offer a cost-effective and time-efficient alternative to traditional cognitive-behavioral and anger management interventions. Conversely, should the intervention prove ineffective, the findings would indicate that this may not be a potential area for further exploration in this population. The study protocol was registered prospectively with the Clinical Trials Registry of India (CTRI) on August 07, 2024 (Registration Number: CTRI/2024/08/072033) (URL: https://ctri.nic.in/Clinicaltrials/rmaindet.php?trialid=113292&EncHid=61291.44954&modid=1&compid=19).

Background A transient increase in anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV) incidence was observed during the coronavirus disease 2019 (COVID-19) pandemic. This study aimed to assess new AAV diagnoses during the COVID-19 pandemic in a single-center cohort. Methods We conducted a retrospective observational study of patients newly diagnosed with AAV at a tertiary care university hospital in Northern Spain between January 2019 and December 2022. Cases were classified according to the 2022 American College of Rheumatology/European Alliance of Associations for Rheumatology (ACR/EULAR) criteria. Clinical and serologic data were collected, including antibody specificity for proteinase 3 (PR3-ANCA) and myeloperoxidase (MPO-ANCA), as well as the temporal relationship to SARS-CoV-2 infection or COVID-19 vaccination. Results A significant increase in AAV incidence was observed during the pandemic, rising from 22.4 cases per million in 2019 to 37.9 cases per million in 2021 ( p = 0.031). Approximately 40% of patients diagnosed during this period had a recent SARS-CoV-2 infection or had been vaccinated against COVID-19 in the preceding 3 months. By 2022, AAV incidence returned to pre-pandemic levels. Contrary to initial trends, demographic and clinical characteristics remained stable; no significant differences were observed in age, gender distribution, disease severity, or organ involvement between the pre-pandemic and pandemic periods. While a numerical increase in PR3-ANCA cases was noted during the pandemic, MPO-ANCA remained the predominant subtype. Conclusion The temporary but significant rise in AAV incidence suggests a possible temporal association with COVID-19 infection or vaccination. These findings underscore the need to conduct larger, multicentre studies to confirm these observations, investigate potential pathophysiological mechanisms, and improve clinical management approaches.

Pulmonary tuberculosis (TB) produces systemic alterations that can be reflected in biochemical parameters beyond microbiological resolution. Early characterization of the biochemical response to treatment could provide additional criteria for following up with hospitalized patients. A retrospective observational study was conducted focusing on patients with pulmonary TB from a tertiary care hospital, based on biochemical parameters upon admission (“before”) and between 2 and 10 days after starting anti-tuberculosis treatment (“after”). The patients were grouped into three clusters according to the results of the clinical tests: mild (70.1%), inflammatory (26.7%), and severe (3.2%). After the start of treatment, 30% of the patients migrated toward the most biochemically compromised phenotype (Cluster 3). Sixty-one percent showed deterioration in at least one of the three key parameters; only 12.8% improved simultaneously. Significant associations were identified between unfavorable biochemical evolution and HIV (p = 0.004) or patients with public health coverage (p = 0.01). Overall, after antituberculous therapy, a reduction in CRP and leukocytes was observed (p &lt; 0.001), and progressive anemia (ΔHb: −1.7 g/dL) and renal deterioration (ΔCr: +0.52 mg/dL) were identified. The identification of dynamic phenotypes in patients with pulmonary TB can be used to establish early risk markers and contribute to individualized clinical surveillance.

Abstract: OBJECTIVE: The objective of this study was to assess the health-related quality of life (HRQoL) in COVID-19 patients at discharge and 6 months post-discharge following a guided exercise prescription. METHODS: This cross-sectional study comprised 42 patients diagnosed with COVID-19 recruited from a tertiary care hospital. The demographic and clinical characteristics of the participants such as age, gender, co-morbidities, computed tomography severity score, CO-RADS category, hospitalization days, oxygen support, and intensive care unit (ICU) admission were documented. HRQoL using EuroQol 5-dimensional-5 levels (EQ-5D-5L) was assessed at two timelines: (1) at discharge and (2) 6 months post-discharge. Participants were given a well-structured written home program comprising breathing exercises, general mobility exercises, and functional training at discharge and were advised to follow up for physiotherapy services. Regular telephonic communication was done to ensure adherence to exercise and monitor the patient’s health status. RESULTS: The study comprised 42 participants having a mean age of 49.86 ± 15.83 years. 11.90% ( n = 5) of participants were admitted to the ICU during initial stay at the hospital. 54.76% ( n = 23) of participants were on oxygen support. Overall, only 21.62% ( n = 08) came for follow-up to the physiotherapy outpatient department post-discharge. A significant difference was observed in EQ-5D-5L dimensions along with a significant difference while comparing the EuroQol Visual Analog Scale score at discharge and after 6-month follow-up ( P = 0.00). CONCLUSION: The quality of life of COVID-19 patients was significantly affected at discharge which showed steady improvement after six months following a guided-exercise program.

Management of ventilator and venovenous extracorporeal membrane oxygenation (ECMO) settings in critically ill adults requires individualized decisions to balance oxygenation, ventilation, and complication risks. Existing approaches rely heavily on clinician experience, with limited decision support tools available. An offline reinforcement learning agent trained on real-world venovenous ECMO clinical data can generate safe, interpretable, and clinically aligned recommendations for ECMO and ventilator management, including support for earlier and more efficient weaning. We conducted a retrospective study using electronic health record data from 184 adult patients who underwent venovenous ECMO at a tertiary care center. rECMOmender was developed using conservative Q-learning with a physiologically informed reward structure. Multiple model variants were compared across discrete and continuous action spaces and two reward formulations. Performance was assessed using fitted Q evaluation, comparison of action distributions, and alignment with clinician practice. rECMOmender generated stable, interpretable recommendations across five key parameters: Fio2, positive end-expiratory pressure (PEEP), respiratory rate, sweep gas flow, and blood flow rate. It selected Fio2 values in the 40-50% range most frequently (46.75% vs. 45.65% for clinicians) and favored PEEP of 9-11 cm H2O (43.94% vs. 34.28%), while using high PEEP settings (13-20 cm H2O) 73.43% less often. Compared with clinicians, rECMOmender increased large parameter shifts (> 1 bin) by 72.53% for Fio2, 348.15% for PEEP, 299.21% for respiratory rate, 96.68% for sweep gas, and 34.16% for blood flow, resulting in an overall 120.37% increase in major adjustments (3105 vs. 1409). rECMOmender demonstrated dynamic but safety conscious adjustments that aligned with clinical patterns, indicating potential as a decision support tool that complements clinician judgment.

A "Code Blue" is a term to activate an alarm for the resuscitation team for a patient who has a cardiopulmonary arrest. The role of a pediatric otolaryngologist in a tracheostomy-related code blue case is not clearly defined. We aim to describe the role of pediatric otolaryngologists in pediatric tracheostomy code blue (PTCB) cases. This retrospective study analyzed pediatric code blue cases in a tertiary care hospital from January 2019 to December 2022, before and after the implementation of a standardized PTCB that includes a pediatric otolaryngologist in the resuscitation team. Primary outcome variables included response time and survival-to-discharge of patients. The most common reason for code activation was reduced oxygen saturation. The leading cause for the otolaryngology consultation was tube blockage. Tracheostomy tube change was the most common intervention performed. The mean time of otolaryngology arrival was significantly decreased from 14.0 min pre-implementation to 4.0 min post-implementation (p < 0.001). While including all 48 PTCB events, pediatric otolaryngologist involvement was significantly associated with higher survival-to-discharge (94.4% vs. 66.7%, p = 0.028). While comparing post-PTCB protocol implementation versus pre-implementation, mortality declined from 23.8% to 3.7% with increased discharge rates, although this did not reach statistical significance (p = 0.073). Inclusion of a pediatric otolaryngologist in the resuscitation team reduces time-to-arrival of the pediatric otolaryngologist to the code blue activation site. Reduced time to pediatric otolaryngologist arrival and completion of interventions by pediatric otolaryngologist are associated with reduced mortality in PTCB events.

To compare the clinical outcomes of radiofrequency ablation of the intraturbinate segment of the posterior nasal nerve (RAPN) alone versus combined RAPN with CO₂ laser posterior nasal nerve neurolysis (RPN3) in patients with chronic rhinitis refractory to medical therapy. Retrospective cohort study. Single tertiary care center. Adult patients with chronic rhinitis unresponsive to medical treatment for over 6 months who underwent either RAPN or RPN3 between February 2023 and May 2024 were included. Inclusion criteria were 24-hour reflective total nasal symptom score (rTNSS) ≥ 3, rhinorrhea score ≥1, and NOSE score ≥11. Exclusion criteria included chronic rhinosinusitis, nasal polyps, and coagulopathy. Demographics and comorbidities were documented. Primary endpoints were changes in rTNSS, NOSE scores, and response rate (≥30% improvement from baseline) at 1-, 3-, and 6-months posttreatment. A total of 101 patients were analyzed (RPN3: 76; RAPN: 25). Baseline rTNSS and NOSE scores were comparable between the two groups (P = .144 and .414, respectively). Both groups demonstrated significant improvements in rTNSS and NOSE scores at all follow-up points (P < .001). From 1 to 6 months, RPN3 achieved significantly greater improvements compared to RAPN (P = .039-.045), particularly in the rhinorrhea and nasal itching sub-scores (P = .003-.039). Response rates for rTNSS ranged from 91% to 100% in the RPN3 group and 84% to 96% in the RAPN group. Both RAPN and RPN3 are effective in treating chronic rhinitis unresponsive to medication. The addition of CO₂ laser posterior nasal nerve neurolysis (RPN3) provides superior symptomatic relief, particularly for rhinorrhea and nasal itching.

Abstract Introduction: Antimicrobial resistance (AMR) poses a critical challenge in global health, with a particularly severe impact in developing countries. The increasing resistance among bacterial pathogens complicates empirical therapy, especially in tertiary care settings. This study analyzed antimicrobial susceptibility patterns of bacterial isolates from a private tertiary care hospital in Srinagar, Jammu and Kashmir. Materials and Methods: A prospective observational study was conducted from June 2023 to December 2024. A total of 2101 clinical specimens were collected from outpatient department (OPD), inpatient department (IPD), and intensive care unit (ICU) settings. Bacterial identification was performed using the Vitek 2 system, and antimicrobial susceptibility testing followed Clinical and Laboratory Standards Institute guidelines. Results: Of the 410 clinically significant isolates, Escherichia coli was the most prevalent, particularly in OPD samples. High methicillin resistance in Staphylococcus aureus and vancomycin resistance in enterococci were noted, especially in ICU settings. ICU isolates, especially Klebsiella , showed marked carbapenem resistance. Multi-drug resistance (MDR) was most common in ICU (58%), with extensively drug-resistant at 22%. The empirical therapy model indicated lower predicted success in ICU compared to OPD and IPD. Conclusion: The high prevalence of MDR, particularly in ICU settings, underscores the need for strict antimicrobial stewardship and infection control. Tailored empirical therapy based on local resistance patterns is essential to improve patient outcomes.

Rituals with spiritual or symbolic meaning form an integral part of pediatric intensive care, yet their timing, initiators, and contextual functions remain insufficiently described. In secularizing and religiously diverse societies, understanding how such practices are documented and enacted is essential for ethically grounded care. This study characterizes sacramental and symbolic rituals in a German tertiary neonatal and pediatric intensive care unit (NICU/PICU), examining initiation patterns, faith alignment, and survival-related timing. We conducted a retrospective descriptive analysis of 135 neonates and infants who received a documented ritual between 2013 and 2024. Rituals were categorized as sacramental or symbolic. Initiators, performers, clinical context, and survival category were recorded. Faith alignment was defined by the correspondence between family affiliation and ritual performer. Data from chaplaincy and clinical documentation were analyzed descriptively. Most rituals were initiated by healthcare staff (≈ 67%) and performed by clergy (≈ 70%). Rituals occurred across the full range of survival outcomes but clustered in intermediate prognostic categories, where uncertainty was greatest. Symbolic and staff-led rituals were used predominantly in time-critical situations, particularly when clergy were unavailable or denominational alignment was unclear. Cross-faith rituals were rare and mainly observed in acute phases. Ritual-faith congruence increased with longer survival trajectories. No distinct non-sacramental religious rituals were documented, likely reflecting under-capture of informal practices. Ritual practice in pediatric intensive care extends well beyond last rites, encompassing symbolic, anticipatory, and adaptively tailored acts integrated into routine clinical care. These patterns reflect the influence of urgency, availability, and cultural diversity on ritual expression. Documentation gaps limit full quantification and underscore the need for prospective, mixed-methods studies and inclusive institutional frameworks for culturally and spiritually responsive care.

This study aimed to compare the feeding outcomes of extremely premature infants (EPI, <28 weeks' gestational age) cared for by the same neonatology group at two tertiary neonatal intensive care units that employed two different oral feeding strategies (cue-based oral feeding progression [CB-OFP] and volume-based oral feeding progression [VB-OFP]).We conducted a retrospective cohort study of EPI (July 1, 2022, and April 12, 2024) patients discharged on full oral feedings. The primary outcome was postmenstrual age (PMA) when full oral feeding was achieved. Secondary outcomes included time to full oral feeds, PMA and weight at initiation and discharge, growth velocity, and length of hospital stay.Baseline characteristics were similar among 119 EPIs (CB-OFP: n = 61; VB-OFP: n = 58) except for maternal magnesium sulfate exposure and postnatal steroid use. CB-OFP infants achieved full oral feeding at an earlier PMA (median: 37.6 vs. 40.1 weeks; p < 0.001) and in fewer median days (20 vs. 27 days; p = 0.03). CB-OFP was also associated with earlier discharge (median PMA at discharge: 38.6 vs. 41.3 weeks; p < 0.001) and shorter length of stay (93 vs. 111.5 days; p < 0.001). Growth velocity and discharge weight z-scores did not differ significantly between groups.Our experience suggests that a CB-OFP strategy may be associated with earlier attainment of full oral feeds and a shorter length of stay compared with VB-OFP. Future randomized controlled trials are warranted to validate these findings and to assess potential long-term neurodevelopmental outcomes with different feeding strategies. · There is no consensus on the optimal oral feeding progression strategy for EPIs.. · A CB-OFP strategy was associated with earlier achievement of full oral feeding and a shorter length of stay.. · Oral motor interventions, including stimulation exercises, may play a role in improving oral feeding abilities in EPIs..

Offline AI-assisted fundus imaging for preliminary screening of childhood glaucoma.

Objectives: This study aims to evaluate the surgical outcomes following retropupillary iris claw intraocular lens (IC-IOL) implantation in aphakic patients by assessing the post-operative outcomes in terms of best corrected visual acuity (BCVA), intraocular pressure (IOP), corneal endothelium status (via specular microscopy) and any complications following retropupillary implantation of IC-IOLs in primary or secondary aphakia. Materials and Methods: This was a prospective interventional study conducted at a tertiary eye care centre of western India from January 2023 to August 2024. Fifty eyes of 47 aphakic patients (post-cataract surgery complications, congenital or traumatic lens subluxation) underwent retro-pupillary IC IOL implantation. Comprehensive pre-operative and post-operative evaluations included: BCVA, IOP, Corneal endothelial cell density (ECD) and complications. Follow-up was conducted at 1 day, 1 week, 1 month, 3 months and 6 months postoperatively. Results: Mean LogMAR BCVA improved from 1.16 ± 0.21 preoperatively to 0.41 ± 0.12 postoperatively ( P &lt; 0.001). There was minimal ECD loss (2%, P = 0.02), with no cases of corneal decompensation and no significant long-term IOP elevation (mean 13.56 ± 2.83 mmHg, P = 0.028 vs. baseline). The complications noted were: pupil distortion (18%), pigment dispersion (10%), retinal detachment (6%) and macular oedema (2%). Conclusion: Retropupillary IC IOL implantation is a safe and effective method for aphakia correction, offering significant visual rehabilitation with minimal impact on corneal endothelium and IOP. It presents fewer complications compared to alternative techniques, making it a viable option for aphakic patients.

Background: Chemotherapy-induced anaemia (CIA) is a common complication in cancer patients and can negatively affect treatment continuity and quality of life. The severity of anaemia may vary depending on the chemotherapeutic drug class. This study aimed to evaluate the incidence, severity, management, and outcomes of CIA in a tertiary care hospital. Methods: A retrospective observational study was conducted among 100 cancer patients who received chemotherapy between January 2024 and December 2024. Demographic data, cancer diagnosis, chemotherapy regimens, haemoglobin levels before and after chemotherapy, anaemia grading, management strategies, and outcomes were collected. Haemoglobin changes were analysed using paired t-test, and differences between drug classes were assessed using one-way ANOVA. Results: Mean haemoglobin levels decreased significantly from 13.40±0.90 g/dl before chemotherapy to 9.49±1.47 g/dl after chemotherapy (mean reduction 3.91±1.65 g/dl; p&lt;0.001). Grade 1 anaemia was observed in 52% of patients, grade 2 in 27%, grade 3 in 15%, and grade 4 in 6%. Haemoglobin reduction differed significantly among drug classes (F=5.917, p=0.0001), with greater reductions seen with alkylating agents, taxanes, and PD-1 receptor inhibitors. Iron therapy (40%) and blood transfusions (19%) were the most common management strategies. Clinical improvement was observed in 97% of patients. Conclusions: Chemotherapy causes a significant reduction in haemoglobin levels, with variability across drug classes. Regular monitoring and appropriate management of anaemia are essential during chemotherapy.

Abstract Objectives Sickle Cell Disease (SCD) is a rare, inherited blood disorder causing acute and chronic complications that affect physical, psychological, and social well-being. This study examines SCD patient characteristics using a biopsychosocial model integrating biological, quality-of-life (QoL), and social factors across life stages. Methods This observational study, conducted between November 2022 and July 2024 at a tertiary care hospital in Northern Italy, included patients aged 4–25 years with confirmed SCD. Participants underwent cognitive and QoL assessments; genotype, hospital visits, treatments, and socio-demographic data were collected. Wechsler scales assessed intellectual abilities; PROMIS questionnaires measured QoL. Analyses were performed with SPSS. Results Eighty-nine patients were enrolled. Profiles showed age-related clinical, cognitive, and psychosocial variations. Around 45% reported anxiety and depression, and 50% experienced social isolation and pain interference. Adolescents and young adults (12–25 years) exhibited higher psychological vulnerability—depression, pain interference, and fatigue—than younger groups (p&amp;lt;.007). Cognitive performance was below normative means, particularly in executive functions (p=.039). Working memory and processing speed were most affected, declining with age. Significant differences emerged in Verbal Comprehension [F(3,82)=6.473, p&amp;lt;.001] and Perceptual Reasoning [F(3,82)=2.987, p=.036], with poorer outcomes in older participants. Visuospatial skills were relatively preserved but declined in young adults. Conclusions Age-specific risk patterns highlight the need for developmentally tailored, multidisciplinary care. Early detection of cognitive and emotional vulnerabilities, together with preventive strategies, may reduce long-term complications and improve QoL. However, the cross-sectional design of the study limits causal inferences. Overall, findings support holistic care models addressing medical, cognitive, psychological, and social dimensions of SCD.

Prevalence and Risk Factors of Gastroesophageal Reflux Disease among Adults Attending a Tertiary Care Hospital in South India: A Prospective Observational Study

Homicide represents a critical public health and legal challenge in Bangladesh, claiming numerous lives and reflecting underlying social tensions. A precise understanding of its patterns is crucial for informing violence prevention strategies and guiding effective policy and policing interventions. A cross-sectional study was conducted in the Department of Forensic Medicine &amp; Toxicology of Cumilla Medical College, Cumilla, Bangladesh, between July 2024 and June 2025, to assess the patterns of homicidal deaths based on autopsy findings. We analyzed 197 purposively selected homicide cases from autopsy procedures. Data was analyzed using MS-Excel to generate descriptive statistics on victim demographics and injury patterns. Our data revealed that young males (75.6%), particularly in 21–40 years age group (62.4%) were the most common victims. Sharp weapon injuries were the predominant cause of death (47.2%), followed by firearms (24.4%). Most incidents occurred outdoors (51.8%) during night hours (39.6%) and were motivated by interpersonal disputes (41.1%). No significant association was found between the victim's age and the cause of death (p=0.961). To conclude, young males are the primary victims of homicide, predominantly from sharp weapon injuries in interpersonal disputes. Targeted interventions, including stricter weapon regulation and community conflict resolution programs, are urgently recommended to mitigate this public health burden. CBMJ 2026 January: vol. 15 no. 01 P:121-126

Anxiety disorders frequently co-occur with major depressive disorder (MDD), potentially complicating clinical presentation and treatment outcomes. Anxiety disorders can exacerbate symptoms and impact the overall quality of life, necessitating comprehensive diagnostic and therapeutic approaches. A cross-sectional study was conducted at the Department of Psychiatry, Community Based Medical College, Bangladesh (CBMC,B) Hospital, Mymensingh, Bangladesh, between January and June of 2021, to evaluate the prevalence, features, and severity of anxiety disorders in patients with major depressive disorder. A total of 77 patients with major depressive disorder attending the outpatient department (OPD) of the hospital were enrolled in this study through convenient purposive sampling technique. The severity of anxiety was assessed using the Hamilton Anxiety Rating Scale (HAM-A). Demographic and clinical data was recorded and analyzed. The HAM-A scale indicated that 29.9% of participants had mild anxiety (score ≤17), while 44.2% had mild to moderate anxiety levels (score 18-24). Those who experienced moderate to severe anxiety (score 25-30) comprised 20.8% and 5.2% experienced severe anxiety (score &gt;30). In 46.8% of participants, the anxiety types were identified. Approximately 24.7% were diagnosed with generalized anxiety disorder, while obsessive-compulsive disorder was found in 7.8%, and panic disorder in 5.2% of the cases. Almost half of individuals with major depressive disorder (MDD) may also experience mild to moderate anxiety disorders. Generalized anxiety disorder is the most prevalent, potentially affecting about one-fourth of MDD cases. CBMJ 2026 January: vol. 15 no. 01 P:162-167

Abstract Background: Thyroid disorders are common endocrine conditions requiring long-term pharmacological management. Drug use pattern studies help evaluate prescribing practices and promote rational drug use. Objective: To assess the drug use pattern in patients with thyroid disorders and to analyze their demographic and laboratory characteristics. Methods: A prospective observational study was carried out among patients diagnosed with thyroid disorders in a tertiary care hospital. Data regarding demographics, laboratory investigations, and prescribed medications were collected using a structured proforma and analyzed descriptively. Results: Thyroid disorders were more prevalent among females and middle-aged individuals. Most patients showed laboratory features of hypothyroidism, including elevated TSH and reduced free thyroid hormone levels. Levothyroxine monotherapy was the most commonly prescribed treatment, while combination therapy was rarely used. Adjunct medications such as statins and nutritional supplements were prescribed based on associated comorbidities. Lifestyle and dietary advice was provided to all patients. Conclusion: Levothyroxine monotherapy remains the cornerstone of thyroid disorder management. The observed prescribing pattern reflects rational and guideline-based therapy, emphasizing the importance of comprehensive patient care.