IMPORTANT NOTICE: Manuscript Submission and Editorial Contact Researchers and authors are invited to submit their articles through email. For submissions and all editorial inquiries, contact: cuestionesdefisioterapia.editor@gmail.com Communication email for Cuestiones de Fisioterapia is: editor@cuestionesdefisioterapia.com , So, we inform you to communicate through this given email only. Sending communication to any other email id will not be considered for enquiries or submissions. The journal CUESTIONES DE FISIOTERAPIA journal publisher is a organization that produces and distributes scientific journal focused on various aspects of medicine, healthcare, and life sciences. The journal CUESTIONES DE FISIOTERAPIA play a crucial role in disseminating research findings, reviews, and editorials to the medical community, academia, and industry professionals. The journal CUESTIONES DE FISIOTERAPIA - online journal with open access options - Manage the peer-review process to ensure manuscript quality and validity - Work with editors, reviewers, and authors to improve manuscript quality - Provide indexing and abstracting services to increase journal visibility - Maintain ethical standards and publication integrity - Offer reprints, permissions, and licensing services - Keep up with industry trends, technological advancements, and changing research landscapes The journal CUESTIONES DE FISIOTERAPIA specialize in specific Physician therapy or cover a broad range of topics, contributing to the advancement of social science knowledge. NOTE: Please be aware that Cuestiones de Fisioterapia does not guarantee indexing of any kind. Indexing is entirely at the discretion of the indexing authorities and not the publisher. Our responsibility as publishers is to maintain high standards of publication quality, but the ultimate decision on indexing lies with the indexing agencies. Additionally, the Article Processing Charges (APC) are a one-time fee for editing, reviewing, and publishing your manuscript on our journal's website. This fee enables Golden Open Access, allowing researchers worldwide to read and cite your published work freely.
You are free to: Share — copy and redistribute the material in any medium or format for any purpose, even commercially. Adapt — remix, transform, and build upon the material for any purpose, even commercially. The licensor cannot revoke these freedoms as long as you follow the license terms. Under the following terms: Attribution — You must give appropriate credit , provide a link to the license, and indicate if changes were made . You may do so in any reasonable manner, but not in any way that suggests the licensor endorses you or your use. No additional restrictions — You may not apply legal terms or technological measures that legally restrict others from doing anything the license permits. Notices: You do not have to comply with the license for elements of the material in the public domain or where your use is permitted by an applicable exception or limitation . No warranties are given. The license may not give you all of the permissions necessary for your intended use. For example, other rights such as publicity, privacy, or moral rights may limit how you use the material.
Prognostic Determinants in Acute Paracetamol Toxicity: Integrating Clinical Features and Biomarkers for Outcome Prediction
Background: Acute paracetamol (acetaminophen) toxicity remains a leading cause of drug-related acute liver injury and acute liver failure worldwide. Although early antidotal therapy with N-acetylcysteine (NAC) markedly improves prognosis, outcome prediction is still challenging in several real-world scenarios: uncertain time of ingestion, delayed presentation, staggered or repeated supratherapeutic dosing, co-ingestions, and patients with evolving multiorgan dysfunction.
Paracetamol; acetaminophen; overdose; acute liver injury; acute liver failure; prognosis; risk stratification; biomarkers; INR; lactate; hypoglycemia; renal injury; N-acetylcysteine; clinical toxicology.
Nada Mohamed Mohamed Abdelhady, Omaima Ibrahim Abdel Hamid, Manar Ali Elsayed, Wafaa Ibrahim Soliman
Copyright (c) 2026 https://creativecommons.org/licenses/by/4.0/deed.en
Bile Reflux Gastritis in Patients with Chronic Heartburn: Prevalence, Pathophysiology, and Clinical Relevance
Chronic heartburn is a prevalent gastrointestinal complaint traditionally attributed to acid-mediated gastroesophageal reflux disease (GERD). However, increasing evidence suggests that non-acid components, particularly duodenogastric bile reflux, play a significant yet under recognized role in the pathogenesis of persistent upper gastrointestinal symptoms
Bile Reflux Gastritis, Chronic Heartburn
Amira Sameh Abdelkader, Sameh M. Abdel Monem , Ibrahim M. Ibrahim , Ola A. Harb , Mai Saad Ghanem
TSH Receptor Gene Polymorphisms in Graves' Disease and Graves' Ophthalmopathy: Current Evidence, Molecular Mechanisms, and Clinical Implications
Background: Graves' disease (GD) is the most common cause of autoimmune hyperthyroidism and results from a complex interplay between genetic susceptibility, immune dysregulation, and environmental triggers. Among the numerous genetic loci implicated in disease pathogenesis, the thyroid-stimulating hormone receptor (
TSH Receptor Gene, Polymorphisms, Graves' Disease, Graves' Ophthalmopathy
Farid Fawzy Abd El-Hafiz , Khalid Ahmed Ahmed Elbanna , Nermin Saad Ghanem, Norhan Abdallah Said Sabbah , Abdelhamid Moustafa Abdelhamid Elmougi
Developing Strategies to Enhance Throughput among Technical Nurse Students
Background: Nursing education plays a vital role in promoting public health and advancing healthcare systems worldwide, making the development of strategies to enhance throughput crucial for ensuring timely graduation and meeting healthcare demands. Aim of the study: This study aimed to develop strategies to enhance throughput among technical nurse students at Al- Sharkia governorate
Strategies, throughput, academic failure, Student nurse and nursing educator
Fawzya Abd-Elrahman Farid, Magda Atiya Gaber , Wafaa Mostafa Mohamed
Interplay Between Vitamin D Status and Iron Deficiency Anemia in Pediatric Type 1 Diabetes: A Narrative Review
Background: Type 1 diabetes mellitus (TIDM) is one of the most common chronic endocrine disorders affecting children and adolescents worldwide and is frequently associated with multiple metabolic and nutritional disturbances. Among these, vitamin D deficiency and iron deficiency anemia (IRON DEFECIENCY ANEMIA) have emerged as important comorbidities
Vitamin D Status, Iron Deficiency Anemia, Pediatric , Type 1 Diabetes
Tarek Abdelrahman Mohamed Attia , Naglaa Ali Khalifa , Omar Magdy Badawy Badawy , Mohamed Ragab Abdellatif
Background: Type 1 diabetes mellitus (TIDM) is one of the most common chronic endocrine disorders affecting children and adolescents worldwide and is frequently associated with multiple metabolic and nutritional disturbances. Among these, vitamin D deficiency andiron deficiency anemia (IRON DEFECIENCY ANEMIA) have emerged as important comorbidities that may adversely
Diagnostic Performance of the Kaiser Score for Characterization of Breast Lesions on Unenhanced Breast MRI: A Comprehensive Review
Background: Breast magnetic resonance imaging (MRI) is recognized as the most sensitive imaging modality for the detection and characterization of breast cancer. Conventional breast MRI relies heavily on dynamic contrast-enhanced MRI (DCE-MRI), which provides both morphological and kinetic information for lesion assessment. However, concerns regarding gadolinium-based contrast
Kaiser Score , Breast Lesions ,Unenhanced Breast MRI:
Ahmed Mohamed Waffdy Algebally, Nesma Adel Zaid, Basma Kamal Soliman, Noura Omar Abdelfatah
Role of Lung Ultrasound in the Evaluation of Systemic Sclerosis: Relationship with Functional Impairment and Patient-Reported Outcomes
Systemic sclerosis (SSc) is a chronic autoimmune connective tissue disease characterized by widespread microvascular injury, immune dysregulation, and progressive fibrosis affecting the skin and internal organs. Among its visceral complications, systemic sclerosisassociated interstitial lung disease (SSc-ILD) represents one of the leading causes o
Lung Ultrasound , Systemic Sclerosis: Functional Impairment
Ghada Abdel Azeem Mohamed, Yassir Abdelhay Abdelhameed, Ghada Aboelsaud Dawa, Dalia Anas Ibrahim
PREVALENCE AND RISK FACTORS OF PTERYGIUM AMONG OUTDOOR WORKERS ATTENDING AN OPHTHALMOLOGY OUTPATIENT DEPARTMENT: A CROSS-SECTIONAL STUDY
Background and Purpose: The purpose of this study is to compare the effect of walking with diet control and step aerobics with diet control on body mass index, waist circumference and blood pressure in obese women. METHODS: This is an Experimental study in which 30 subjects were randomly assigned to Group A and B. Group A performed Brisk Walking with diet control. Group B performed step aerobic exercise with diet control. CONCLUSION: The study concludes that step aerobics with diet control is the better intervention reduce BMI, waist circumference and blood pressure in obese women as compared to walking with diet control
EFFECT OF HIGH FREQUENCY (HF) AND LOW FREQUENCY (LF) NEUROMUSCULAR ELECTRICAL STIMULATION (NMES) OF LOWER LIMB MUSCLES ON SYMPTOM PERCEPTION AND FUNCTIONAL WALKING CAPACITY IN SEVERE COPD
Background and Purpose: Neuromuscular Electrical Stimulation (NMES) is a new and emerging modality in the rehabilitation of severely disabled patients with COPD. The objective of the study was to compare the effects of HF (50Hz) and LF NMES (15 Hz) on symptom perception and functional walking capacity in severe COPD patients. Methods: 30 patients, who fulfilled selection criteria were included in this study & were randomly divided into group a & b. group a (n=15) was given conventional physiotherapy & high frequency neuromuscular electrical stimulation & group b (n=15) was given conventional physiotherapy & low frequency neuromuscular electrical stimulation, for a period of 6 weeks. mrc dyspnea scale and vo2 max were taken before and after the treatment in both the groups. results: There was a significant reduction in MRC Dyspnea score and improvement in VO2 MAX in both the groups and a significant difference was found between group A and B (p<0.05). CONCLUSION: The result of the present study suggests that Low Frequency NMES is more effective than High Frequency NMES in reducing symptom perception and improving functional walking capacity, and thereby Low Frequency NMES can be recommended in treating severe COPD patients
Occupational Varicose Veins among School Teachers: Epidemiology, Occupational Risk Factors, Pathophysiological Mechanisms, Clinical Burden, and Preventive Strategies
Background: Varicose veins are among the most common manifestations of chronic venous disease and represent a significant occupational health concern worldwide. Although the condition is influenced by genetic, demographic, and lifestyle factors, occupational exposures play a crucial role in its development and progression. School teachers constitute a unique occupational group that is frequently exposedto prolonged standing, static postures, limited opportunities for movement
Varicose Veins, School Teachers, Occupational Risk Factors
Enjy Ahmed Esmat Khorshid , Ahmed Refat Abd El Ghafaar Ahmed Refat , Marina Farid Abdou Gerges, Dina Sameh Mohammed El Rafey
COMPARISON OF INTRAOCULAR PRESSURE MEASURED BY NON-CONTACT TONOMETRY AND GOLDMANN APPLANATION TONOMETRY IN ADULTS: A HOSPITAL-BASED CROSS-SECTIONAL STUDY
Background: Accurate measurement of intraocular pressure (IOP) is central to the detection and management of glaucoma. Goldmann applanation tonometry (GAT) remains the reference standard, but its requirement for corneal contact, topical anaesthesia and fluorescein, together with a theoretical risk of cross-infection, has prompted interest in non-contact tonometry (NCT) as a screening alternative. Agreement data from South Indian populations are limited. Objective: To assess the agreement between IOP measured by NCT and GAT in adult patients attending a tertiary care teaching hospital in South India. Methods: In this hospital-based cross-sectional method-comparison study, 200 adults underwent IOP measurement by NCT and GAT in the same sitting. The per-patient mean of both eyes was used for analysis. Agreement was evaluated using the paired t-test, Pearson correlation, the intraclass correlation coefficient (ICC) and Bland–Altman limits of agreement, with statistical significance set at p<0.05. Results: The mean age was 52.6 (SD 18.2) years; 109 (54.5%) were men. Mean IOP was 17.47 (SD 2.78) mmHg by NCT and 17.54 (SD 2.89) mmHg by GAT. The mean difference (NCT − GAT) was −0.07 mmHg (SD 0.83), with 95% limits of agreement of −1.70 to +1.56 mmHg; the paired t-test showed no significant systematic difference (p=0.25). Correlation was strong (r=0.957, p<0.001) and agreement was excellent (ICC ≈ 0.96). All paired differences (100%) lay within ±2 mmHg. A non-significant trend toward proportional bias was observed (r=−0.134, p=0.058): NCT read 0.57 mmHg lower at GAT >21 mmHg and 0.29 mmHg higher at GAT <15 mmHg. Conclusion: NCT and GAT demonstrated excellent agreement across the studied IOP range, supporting NCT as a reliable, non-contact screening alternative to GAT in adults. GAT should remain the reference standard for confirmation, particularly at elevated IOP, where NCT showed a slight tendency to under-read.
Intraocular pressure; non-contact tonometry; Goldmann applanation tonometry; Bland–Altman analysis; method comparison; glaucoma screening; South India
Background: Pterygium is a common ocular surface disorder characterised by the fibrovascular proliferation of degenerated conjunctival tissue onto the cornea. Chronic exposure to ultraviolet (UV) radiation and other environmental irritants is strongly implicated in its pathogenesis, placing outdoor workers in tropical regions such as South India at heightened risk. Despite the abundant year-round sunshine of this region, occupation-specific data among outdoor workers remain limited. Objectives: To determine the prevalence of pterygium among outdoor workers attending an ophthalmology outpatient department (OPD) and to identify associated demographic and exposure-related risk factors. Methods: A hospital-based cross-sectional study was conducted among 250 outdoor workers attending the ophthalmology OPD of a tertiary care teaching hospital in South India. All participants underwent slit-lamp biomicroscopic examination for the diagnosis and grading of pterygium, and completed a structured questionnaire capturing occupational and environmental exposure. Data were analysed using descriptive statistics, the chi-square test, and the independent-samples t-test, with p<0.05 considered statistically significant. Results: The mean age was 45.1 (SD 15.4) years; 140 (56.0%) were male. The overall prevalence of pterygium was 24.8% (62/250; 95% confidence interval [CI] 19.4–30.2%). Among affected participants, involvement was bilateral in 23, right-eyed in 22 and left-eyed in 17; severity was graded I in 22, II in 21 and III in 19. The mean duration of outdoor work was significantly greater among those with pterygium than those without (20.4 vs 17.4 years; t=2.00, p=0.046). Gender (p=0.21), dust exposure (p=0.93), protective eyewear use (p=0.95), smoking (p=0.51), age (p=0.93) and daily sun-exposure category (p=0.50) were not significantly associated with pterygium. Conclusion: Pterygium was common in this outdoor-worker population, with cumulative duration of outdoor work emerging as the principal associated factor, consistent with chronic UV and environmental exposure. Most cases were mild-to-moderate, and laterality was fairly even. Promotion of protective measures such as sunglasses and wide-brimmed hats is warranted for long-serving outdoor workers.
Pterygium; Ultraviolet radiation; Outdoor workers; Occupational eye disease; Prevalence; South India
Copyright (c) 2022 Dr.S.Lakshmi (Author) https://creativecommons.org/licenses/by/4.0/deed.en
THE COST AWARENESS AND ECONOMIC DECISION-MAKING OF ORTHOPEDIC SURGEONS: A CROSS-SECTIONAL ANALYSIS OF IMPLANT PRICE ESTIMATION AND CLINICAL PRACTICE PATTERNS
Orthopedic surgery is a technologically developed speciality, which is dependent on the use of implantable medical devices, thus adding to the increasing healthcare expenditures. The aim of the study was to assess the understanding of orthopedic surgeons regarding the cost of implants and also to test the connection between clinical experience and surgical workload, and accuracy of cost estimation. The survey was a cross-sectional and questionnaire based survey of 201 orthopedic surgeons with different practice settings. The questionnaire included demographic information, annual surgery volume, and approximated prices of orthopedic implantation commonly used. Real market prices were also attained with various suppliers to determine differences. These findings showed that the difference between the estimated and actual costs is very high with an average deviation of 47.1, which demonstrates that surgeons are not very aware about cost. It was observed that there was a statistically significant negative relationship between years of experience and estimated prices of some of the devices like shavers and interference screws, indicating that surgeons with more years of experience were likely to underprice them. Subspecialty and cost estimation accuracy did not have any significant association. Also, there was the possibility of being exposed to industry representatives which was found to affect price perceptions. These results indicate that there is a systemic failure of orthopedic surgeons to understand economic awareness, and it is necessary to achieve cost-effective decision-making without reducing the quality of patient care through the incorporation of healthcare economics in the educational process of medical institutions and through the creation of a more open dialogue between clinicians, institutions, and suppliers in medical economics..
Orthopaedic Surgery, Implant Costs, Cost Awareness, Healthcare Economics, Surgeon Decision-Making
Copyright (c) 2024 Dr. Danduru Vasudevava Reddy, Dr. Ashok Reddy (Author) https://creativecommons.org/licenses/by/4.0/deed.en
CLINICAL PATTERNS OF PAEDIATRIC ENDOCRINE DISORDERS IN TAMIL NADU: AN ICD-10 CLASSIFICATION STUDY AT A TERTIARY CENTRE
Aim: To describe the spectrum of various endocrine disorders seen in children and adolescents at Indira Medical College and Hospital, Tiruvallur, Chennai over the period 2019-2023, using the modified European Society of Paediatric Endocrinology ICD-10 classification. Study Design: Descriptive, cross-sectional study. Place and Duration: Paediatric Endocrinology Unit, Department of Paediatrics, Indira Medical College and Hospital, Tiruvallur, Chennai. Study was conducted with data from January 2019 to December 2023. Methods: A retrospective review of 116 patients with various endocrine diseases was carried out. Data on biodata, clinical presentations, investigations and diagnosis were retrieved from clinic records, ward files and the endocrine unit register. Results: A total of 116 patients were seen with various endocrine disorders over the study period, accounting for 3.8% of Paediatric specialist clinic consultations. There were 58 (50.0%) females, 52 (44.8%) males and 6 (5.2%) with genital ambiguity. The ages of patients ranged from 8 days to 17 years with a mean age of 7.4 ± 4.8 years. The commonest endocrine disorders were thyroid disorders, diabetes mellitus, growth disorders, calcium phosphate metabolism and bone disorders, and pubertal disorders in 24 (20.7%), 20 (17.2%), 15 (12.9%), 12 (10.3%) and 11 (9.5%) respectively. Obesity was observed in 10 (8.6%) of patients, and syndromes with endocrine features in 7 (6.0%). Other disorders included sex development and gender disorders, testicular/male reproductive tract disorders, pituitary/hypothalamic disorders, adrenal disorders and ovarian/female reproductive tract disorders in 6 (5.2%), 5 (4.3%), 3 (2.6%), 2 (1.7%) and 1 (0.9%) respectively. Type 1 DM remained the commonest type of DM. Most patients belonged to social class III. Challenges to management included high cost of investigations and medications, and a significant rate of loss to follow-up. Conclusion: Thyroid disorders, type 1 Diabetes mellitus, growth disorders, calcium and phosphate metabolism and bone disorders, and pubertal disorders were the most common conditions identified. There is a need for affordable, locally available diagnostic facilities and trained paediatric endocrinologists to enhance the quality of care for children with endocrine disorders in this region.
Endocrine disorders; children; adolescents; tertiary centre; India; Tamil Nadu
Copyright (c) 2026 Dr. Challa Harisha (Author) https://creativecommons.org/licenses/by/4.0/deed.en
Association Between Serum Vitamin D Levels and Severity of Chronic Plaque Psoriasis: A Hospital-Based Observational Study
Background: Psoriasis is a chronic, immune-mediated inflammatory skin disease in which vitamin D signalling regulates keratinocyte proliferation and T-cell-driven inflammation. Whether circulating 25-hydroxyvitamin D [25(OH)D] is associated with disease severity remains debated, and data from South Indian populations—who experience widespread hypovitaminosis D despite abundant sunlight—are limited. Objectives: To assess the association between serum 25(OH)D levels and the severity of chronic plaque psoriasis among patients attending a tertiary care hospital in South India. Methods: A hospital-based observational comparative study was conducted in 180 patients with chronic plaque psoriasis. Severity was assessed using the Psoriasis Area and Severity Index (PASI) and patients were grouped as mild, moderate or severe. Serum 25(OH)D was measured and categorised as deficient, insufficient or sufficient. Quality of life was recorded with the Dermatology Life Quality Index (DLQI). Associations were examined using one-way ANOVA, the chi-square test and Pearson/Spearman correlation, with p<0.05 considered significant. Results: The mean age was 36.9 (SD 11.5) years and 58.3% were male. Mean PASI was 11.9 (SD 6.7) and mean serum 25(OH)D was 24.3 (SD 9.8) ng/mL; 36.7% of patients were vitamin D deficient and a further 33.3% insufficient. Mean 25(OH)D declined progressively across severity groups—mild 31.1, moderate 21.4 and severe 12.4 ng/mL (ANOVA F=63.3, p<0.001)—and PASI rose stepwise across vitamin D status categories (sufficient 6.4, insufficient 10.6, deficient 17.6; p<0.001). Serum 25(OH)D was strongly and inversely correlated with PASI (r=−0.74, p<0.001), body surface area (r=−0.64, p<0.001) and DLQI (r=−0.54, p<0.001). Vitamin D status and severity group were significantly associated (χ²=64.2, p<0.001). Conclusions: Lower serum vitamin D was strongly and independently associated with greater psoriasis severity and poorer quality of life in this South Indian cohort. While the cross-sectional design precludes causal inference, the findings support assessment of vitamin D status in psoriasis and warrant interventional study of supplementation.
psoriasis; vitamin D; 25-hydroxyvitamin D; PASI; disease severity; South India
Copyright (c) 2026 Dr. Modepalli Pavan Kumar (Author) https://creativecommons.org/licenses/by/4.0/deed.en
Prevalence and Clinical Patterns of Acne Vulgaris Among Undergraduate Students: A Cross-Sectional Study at a Tertiary Care Hospital
Background: Acne vulgaris is one of the most common dermatological conditions affecting adolescents and young adults. Undergraduate students represent a population in which the disease frequently coincides with heightened academic stress and concern about appearance, yet local prevalence and clinical-pattern data are limited. Objectives: To determine the prevalence of acne vulgaris among undergraduate students attending a tertiary care hospital in South India, to describe its clinical patterns and severity, and to quantify its impact on quality of life. Methods: A descriptive cross-sectional study was conducted among 300 undergraduate students. Participants underwent a structured interview and clinical dermatological examination. Acne severity was graded using the Global Acne Grading System (GAGS) and health-related quality of life was measured with the Dermatology Life Quality Index (DLQI). Data were analysed using descriptive statistics, the chi-square test, one-way ANOVA and Pearson correlation, with p<0.05 considered significant. Results: The point prevalence of acne vulgaris was 71.0% (213/300; 95% CI 65.9–76.1%). Prevalence did not differ significantly between female (70.4%) and male (72.1%) students (p=0.86) but was significantly higher among students with a first-degree family history of acne (80.2% vs 65.2%; p=0.008). Among the 213 affected students, acne was mild in 54.0%, moderate in 38.0% and severe in 8.0%. The cheeks were the most commonly involved site (71.4%) and comedones were the most frequent lesion type (85.4%). Mean DLQI score was 5.92 (SD 3.94) and rose significantly with severity (mild 3.90, moderate 7.00, severe 14.47; p<0.001); GAGS and DLQI scores were moderately correlated (r=0.635, p<0.001). Only 34.7% of affected students had ever consulted a dermatologist, whereas 54.9% practised self-medication. Conclusions: Acne vulgaris was highly prevalent in this undergraduate population and exerted a measurable, severity-dependent burden on quality of life, yet formal care-seeking was low. Targeted dermatological education and accessible campus health services are warranted.
prevalence; undergraduate students; Global Acne Grading System
COMPARATIVE ANALYSIS OF CONSERVATIVE AND OPERATIVE TREATMENT STRATEGIES FOR ANKLE FRACTURES: A 12-MONTH PROSPECTIVE STUDY
Background: Ankle fractures are among the most frequently encountered musculoskeletal injuries in orthopedic practice and represent a significant cause of morbidity across all age groups. The management of ankle fractures depends largely on fracture stability, displacement, associated ligamentous injury, and patient-related factors. Stable fractures are often treated conservatively with immobilization and protected weight-bearing, whereas displaced or unstable fractures commonly require surgical fixation to restore anatomical alignment and joint congruity. Despite established treatment principles, comparative evidence regarding functional outcomes and complication profiles remains important for optimizing treatment selection and patient care. Objectives: To compare the functional outcomes, fracture union rates, and complications associated with conservative and surgical management of ankle fractures. Methods: This prospective comparative study included 150 patients diagnosed with ankle fractures and treated according to standard clinical indications based on fracture stability and displacement. Patients underwent either conservative treatment with immobilization or surgical fixation using appropriate operative techniques. Clinical and radiological follow-up was conducted for 12 months. Functional outcomes were assessed using the Olerud–Molander Ankle Score (OMAS) and the American Orthopaedic Foot and Ankle Society (AOFAS) score. Fracture union and treatment-related complications were evaluated. Statistical comparisons were performed using t-tests and chi-square tests, while multivariable analyses adjusted for fracture pattern and baseline demographic and clinical characteristics. Results: Both treatment groups demonstrated satisfactory fracture healing and significant functional improvement at 12 months. Surgical management resulted in significantly higher functional scores and lower rates of malunion among patients with displaced or unstable fractures. However, surgical treatment was associated with a greater incidence of wound-related complications. Stable fractures treated conservatively achieved favorable outcomes comparable to operative management. Conclusion: Individualized treatment based on fracture stability provides excellent outcomes in ankle fractures. Surgical fixation offers superior results for displaced or unstable injuries, whereas conservative management remains an effective option for stable fractures. These findings support an indication-based approach to optimize functional recovery and minimize complications.
Prevalence and Severity of Dry Eye Disease Among Computer Users: A Hospital-Based Cross-Sectional Study
Background: Prolonged use of computers and visual display terminals (VDTs) is increasingly recognised as a contributor to ocular surface discomfort and dry eye disease (DED). Sustained near work reduces blink rate and increases tear-film evaporation, predisposing screen users to symptomatic dry eye. Data from South Indian populations of regular computer users remain limited. Objectives: To estimate the prevalence and severity of DED among regular computer users attending a tertiary care teaching hospital, and to examine the relationship between patterns of computer use and symptom burden using the Ocular Surface Disease Index (OSDI). Methods: A hospital-based cross-sectional study enrolled 220 regular computer/VDT users. Dry eye symptoms were assessed using the validated OSDI questionnaire (score range 0–100). Dry eye status and severity were classified from OSDI cut-offs (normal 0–12; mild 13–22; moderate 23–32; severe 33–100). Descriptive statistics, Pearson correlation, chi-square tests and independent-samples t-tests were applied, with p<0.05 considered significant. Results: Participants had a mean age of 36.4 (SD 11.2) years; 111 (50.5%) were male. Mean daily computer use was 6.7 (SD 2.9) hours. The mean OSDI score was 36.4 (SD 12.9). DED prevalence was 98.2% (216/220; 95% CI 96.4–99.9%). Among those affected, 126 (58.3%) had severe disease. Daily computer-use hours correlated positively and significantly with OSDI score (r=0.507, p<0.001), indicating a dose-response relationship. Dry eye status did not differ significantly by screen-break habit, contact-lens use or air-conditioning (all p>0.05). Conclusions: Symptomatic dry eye was near-universal and frequently severe in this selected sample of computer users, with daily screen-time hours showing a strong dose-response association with symptom severity. The near-universal prevalence should be interpreted as a feature of a highly exposed, self-selected hospital population rather than a general-population estimate.
Association Between Glycaemic Control (HbA1c) and Severity of Diabetic Retinopathy: A Hospital-Based Observational Study
Background: Diabetic retinopathy (DR) is a leading cause of preventable visual impairment among working-age adults worldwide and an increasing burden in India. Glycated haemoglobin (HbA1c) reflects integrated glycaemic control over the preceding two to three months and is a plausible determinant of both the development and the progression of DR. We examined the association between HbA1c and the presence and severity of DR in a South Indian hospital population. Methods: This hospital-based observational cross-sectional comparative study enrolled 200 patients with diabetes mellitus attending a tertiary care teaching hospital in South India. HbA1c was measured for all participants, and DR was graded on dilated fundus examination into No DR, Mild non-proliferative DR (NPDR), Moderate NPDR, Severe NPDR, and proliferative DR (PDR). HbA1c was categorised as good (<7%), fair (7-9%), and poor (>9%). Associations were assessed using the independent t-test, one-way analysis of variance (ANOVA), the chi-square test, and Pearson correlation, with p<0.05 considered significant. Results: The mean age was 56.8 (SD 13.3) years and 105 (52.5%) were female. DR was present in 142 (71.0%; 95% CI 64.7-77.3%). Mean HbA1c was higher in patients with DR than without (8.70% vs 7.35%; t=9.33, p<0.001) and rose stepwise across DR severity (No DR 7.35%, Mild NPDR 8.48%, Moderate NPDR 8.48%, Severe NPDR 9.13%, PDR 10.29%; F=35.08, p<0.001). DR prevalence increased across HbA1c categories (23.8%, 67.5%, 96.4%; chi-square=41.04, p<0.001). Diabetes duration was longer in those with DR (16.5 vs 7.5 years; t=9.00, p<0.001). DR did not differ by hypertension status (p=0.84). Conclusion: Poorer glycaemic control showed a strong, graded association with both the presence and severity of DR, supporting tight glycaemic control and regular retinal screening.
CLINICAL SEVERITY, QUALITY OF LIFE IMPACT, AND PREDICTORS OF SEVERE ATOPIC DERMATITIS IN PAEDIATRIC PATIENTS ATTENDING A TERTIARY DERMATOLOGY CLINIC: A CROSS-SECTIONAL STUDY USING SCORAD AND CDLQI
Background: Atopic dermatitis (AD) is the most common chronic inflammatory skin disease in children, characterised by intense pruritus, sleep disturbance, and profound impairment of quality of life (QoL). Validated instruments—SCORAD for clinical severity and CDLQI for paediatric QoL—enable systematic assessment but are infrequently used in Indian tertiary care settings. This study evaluated disease severity, QoL impact, and predictors of severe AD in a paediatric cohort. Methods: A cross-sectional study enrolled 180 paediatric patients (aged 2–14 years) with physician-confirmed atopic dermatitis using modified UK Working Party criteria at a tertiary dermatology clinic. Disease severity was assessed using SCORAD (Scoring Atopic Dermatitis); QoL using CDLQI (Children's Dermatology Life Quality Index). Pearson correlation between SCORAD and CDLQI was determined. Multivariable logistic regression identified predictors of severe AD (SCORAD >40). Results: Mean SCORAD was 38 ± 16; 23.3% had severe AD (SCORAD >40). Mean CDLQI was 12.4 ± 6.2. SCORAD and CDLQI were strongly correlated (r=0.74; p<0.001). Severe AD patients had significantly worse CDLQI (18 ± 5 vs 8 ± 4; p<0.001), more sleep disruption (4.2 vs 1.8 nights/week), and more missed school days (4.8 vs 1.2 days/month). Independent predictors of severe AD: early onset <6 months (aOR 2.4), elevated IgE >500 IU/mL (aOR 2.2), family history of atopy (aOR 2.1), and comorbid asthma (aOR 1.9). Conclusion: Paediatric AD is associated with substantial QoL impairment strongly correlated with disease severity. Early-onset disease, elevated IgE, atopic family history, and asthma comorbidity predict severe disease. These findings argue for routine SCORAD and CDLQI administration in clinical practice, early specialist referral for high-risk profiles, and systematic QoL assessment to justify stepwise escalation of therapy including biologic agents
EFFICACY OF ULTRASOUND-GUIDED BILATERAL ERECTOR SPINAE PLANE BLOCK AS A COMPONENT OF MULTIMODAL ANALGESIA FOR POSTOPERATIVE PAIN CONTROL AFTER LAPAROSCOPIC CHOLECYSTECTOMY: A PROSPECTIVE COMPARATIVE OBSERVATIONAL STUDY AT A TERTIARY CARE HOSPITAL
The laparoscopic cholecystectomy (LC) remains the gold standard of surgical treatment for symptomatic cholelithiasis. However, it is associated with significant postoperative pain resulting in incisional, visceral and referred shoulder pain. In recent years, ESP-blocks have gained popularity as opioid-sparing analgesics because they spare the spine. During elective laparoscopic cholecystectomy, a prospective comparative observational study evaluating bilateral ultrasound guided ESP block at T7 level compared with MMA alone was conducted. A total of 100 adults were randomly assigned to two groups (50 per group): ESP block plus MMA (paracetamol plus NSAID + rescue tramadol, 0.25% ropivacaine) and control group alone (MMA). A non-random allocation process was used based on consent from patients and anaesthesiologist preference. Over the course of the day, opioid consumption (measured as tramadol equivalents) was the primary outcome. As secondary outcomes, we also assessed NRS pain scores at rest and when moving, time to first use of rescue analgesics, PONV, QoR-15 scores, length of stay, and ambulation time. Results: ESP block group lower ODE consumption by 78 mg over a 24 hour period in comparison to non-ESP group, which sees an increase of 154 mg. (p&lt;0.001). 24 hours after resting, a NRS of 2.1 was observed compared to a NRS of 4.0 (p&lt; 0.001). 7.4 2.8 versus 1.8 0.9 hours was significantly longer during the first rescue analgesic period (7.4 2.8 versus 1.8 0.9). PONV incidence decreased by 50% (16% versus 36%; p = 0.016). In the ESP group, there were higher QoR-15 ratings at 24 hours (130 vs 116; p&lt; 0.001). There was a significant decrease in median LOS (1.8 vs 2.4 days; p 0.001). In the absence of LAST, no cases have been reported. According to multivariable regression analysis, the strongest independent predictor of decreased opioid usage was ESP block (p 0.001; β=−68 mg). An effective laparoscopic cholecystectomy technique that utilizes bilateral T7 ESP block in combination with a multimodal analytic approach can significantly decrease opioid consumption, postoperative pain, PONV, and length of stay after surgery. It appears feasible to implement ESP block routinely in resource-adequate settings for laparoscopic cholecystectomy.
THE DEFICIENCY OF VITAMIN D IS COMMON IN TERTIARY CARE HOSPITAL SUFFICIENTS WITH NONALCOHOLIC FAT LIVER DISEASE, WHICH IS IMPACTED BY HOSPITAL ISSUES
Background: Among the causes of liver disease, non-alcoholic fatty liver disease (NAFLD) is a growing problem. Metabolic syndrome is characterized by fat accumulation in the liver. As an insulin-sensitizing, anti-inflammatory, and antifibrotic compound, vitamin D contributes to NAFLD progression. It is unclear which events caused which events and which events were associated with each other. Methods: In this study, 250 adults with NAFLD who were diagnosed by ultrasound with a Hamaguchi score of 1 were included as subjects. The purpose of this study was to determine serum levels of 25-hydroxyvitamin D [25(OH) D]. Levels of deficiency range from 20 ng/mL to 29 ng/mL, while levels of inadequacy range from 20 to 29 ng/mL. There was an assessment of both the NAFLD Fibrosis Score and the FibroScan. Results: Among the patients, 52.0% were deficient in vitamin D, 28.0% insufficient, and 20.0% sufficient. A higher percentage of those with advanced NAFLD exhibited deficiencies (71.4% compared with 38.2% in Grade 1). Inverse correlation was found between serum 25(OH) D levels and CAP score (r=−0.36) and ALT (r=−0.31). A BMI of 27.5 (an OR of 2.4), metabolic syndrome (an OR of 2.1), and sedentary lifestyle (an OR of 1.8) independently predicted deficiency. Conclusions: Studies have shown that vitamin D deficiency contributes to worsening of hepatic steatosis in patients with NAFLD. Causation should be evaluated in the future, but routine 25(OH) D level screening and lifestyle-optimized vitamin D supplementation may be incorporated into NAFLD management protocols
Phenotypic and Genotypic Characterisation of Carbapenem-Resistant Enterobacterales Isolated from Intensive Care Unit Specimens: A Cross-Sectional Study at a Tertiary Care Hospital
Background: Carbapenem-resistant Enterobacterales (CRE) have become important priority pathogens in the intensive care units (ICUs) worldwide. The ICMR Antimicrobial Resistance Surveillance Network (AMRSN) 2022 provided data on meropenem resistance in clinical Klebsiella pneumoniae isolates in India, which is around 56%, and there is an urgent need for epidemiological data based on the institution. Knowing the local prevalence of CRE, distribution of the carbapenemase genes, the antibiogram profile and risk factors for CRE acquisition is of key importance for developing effective antimicrobial stewardship and infection control measures. Design: This observational cross sectional study was carried out for 18 months in the ICU of tertiary care hospital. All Enterobacterales isolates from clinical samples (blood, urine, respiratory sample, pus, body fluid) of patients on the inpatient wards in the ICU were considered (target n = 420). VITEK-2 automated system and disc diffusion CLSI M100-2024 breakpoints were used to detect carbapenem resistance; and the modified carbapenem inactivation method (mCIM) and EDTA-mCIM were used to confirm the resistance phenotype. Carbapenemase-encoding genes (blaNDM, blaOXA-48-like, blaKPC, blaVIM, blaIMP) were characterised by multiplex real-time PCR. Independent predictors of CRE acquisition were identified using multivariable logistic regression. Results: CRE prevalence was 33.1% (n = 139/420). The most common organisms were Klebsiella pneumoniae (40.3%), Escherichia coli (28.1%) and Enterobacter spp. (18.7%). The blaNDM gene was identified in 55.4% of CRE isolates, blaOXA-48-like in 25.2% and both carbapenemases in 12.2%. 88.5% of CRE isolates were colistin susceptible, and 62.2% of them were ceftazidime-avibactam susceptible (significantly less among blaNDM producers, p < 0.001). Independent predictors of CRE acquisition were prior carbapenem use (adjusted OR 4.1; 95% CI 2.3–7.2), ICU stay >7 days (aOR 3.2; 95% CI 1.9–5.4), and mechanical ventilation (aOR 2.6; 95% CI 1.5–4.6). NDM was the most common carbapenemase and the prevalence of CRE in the ICU was significant. Ceftazidime-avibactam was still active, particularly against the NDM producers. Active surveillance, contact precaution bundles and antimicrobial stewardship are all needed now. The results correlate with the national AMRSN standards and highlight the importance of prompt genotypic characterisation for prompt salvage therapy
THE IMPACT OF POSTOPERATIVE COMPLICATIONS ON 30-DAY READMISSION AFTER GENERAL SURGERY
In this prospective cohort study, unplanned 30-day readmission following general surgical procedures occurred in 12% of patients, highlighting a substantial burden on both healthcare resources and patient outcomes. The analysis demonstrated that postoperative complications during the index admission were the strongest predictors of readmission, increasing the likelihood of rehospitalization by more than threefold. Surgical-site infection emerged as another major determinant, emphasizing the ongoing impact of wound-related complications on postoperative recovery. Patients undergoing emergency surgery were also at elevated risk, likely reflecting greater disease severity, limited opportunities for preoperative optimization, and higher rates of postoperative morbidity. Similarly, prolonged index hospital stay was independently associated with readmission, suggesting that extended hospitalization may serve as a marker of clinical complexity and unresolved recovery issues. Diabetes mellitus contributed significantly to readmission risk, consistent with its known effects on wound healing, infection susceptibility, and postoperative recovery. Wound-related and gastrointestinal complications represented the most common reasons for readmission, indicating key targets for preventive interventions. These findings underscore the importance of comprehensive perioperative care strategies that extend beyond the initial hospital stay. Enhanced infection-prevention measures, meticulous postoperative monitoring, optimized glycaemic control, and early recognition of complications may substantially reduce readmission rates. Furthermore, structured discharge planning, patient education regarding warning symptoms, medication reconciliation, and timely post-discharge follow-up could facilitate earlier intervention and prevent avoidable rehospitalizations. The study supports the use of risk-based discharge pathways that prioritize high-risk patients, particularly those with postoperative complications, diabetes, emergency surgical admissions, and prolonged hospital stays. Future multicentre studies are warranted to validate these findings and evaluate targeted interventions designed to reduce readmission and improve long-term surgical outcomes
Clinical Profile and Management Outcomes of Acute Appendicitis in Patients Undergoing Appendicectomy: A Hospital-Based Study
Abstract Background: Acute appendicitis is the commonest abdominal surgical emergency, yet its diagnosis remains clinically challenging. The negative-appendicectomy rate and the perforation rate are widely used quality metrics that reflect, respectively, diagnostic accuracy and timeliness of surgical intervention. Contemporary data from South India are limited. Objectives: To describe the clinical, investigative, operative and histopathological profile of patients undergoing appendicectomy for suspected acute appendicitis, and to evaluate management outcomes against established quality benchmarks. Materials and Methods: A hospital-based observational study was conducted at a tertiary care teaching hospital in South India, enrolling 200 patients who underwent appendicectomy for suspected acute appendicitis. Clinical, operative and histopathology records were reviewed. Perforation was defined operatively, and negative appendicectomy as histologically normal appendix. Data were analysed using descriptive statistics, the chi-square test and the independent-samples t-test, with p<0.05 considered significant. Results: The mean age was 40.3 (SD 17.5) years; 102 (51.0%) were female. The mean duration of pain was 51.7 (SD 26.5) hours and the mean total leucocyte count was 14,421 (SD 4,620)/mm³. Perforation was present in 93 patients (46.5%; 95% CI 39.6–53.4%). The negative-appendicectomy rate was 21.5%. The mean hospital stay was 5.9 (SD 2.9) days. Hospital stay did not differ by operative approach (laparoscopic 6.1 vs open 5.6 days; p=0.20) or by perforation (p=0.77). No measured variable was associated with perforation. Conclusion: A high perforation rate and a notable negative-appendicectomy rate, both exceeding commonly cited benchmarks, indicate scope to improve diagnostic accuracy and timeliness of surgery. Laparoscopic and open approaches yielded comparable outcomes.
DEVELOPMENTAL CONSEQUENCES OF UNDERNUTRITION IN EARLY CHILDHOOD: A CROSS-SECTIONAL STUDY
A total of 300 children were included in the study and assessed for both nutritional status and developmental outcomes. Undernutrition was common, with substantial proportions of children exhibiting stunting, underweight, and wasting according to WHO anthropometric standards. Developmental screening identified delays across multiple domains, including gross motor, fine motor, language, cognitive, and social development, with language delay being the most frequently observed deficit. Children with indicators of undernutrition demonstrated significantly higher rates of developmental delay compared with their well-nourished peers. The prevalence of developmental delay was greatest among stunted children, followed by those who were underweight and wasted. Language and cognitive domains showed the strongest associations with poor nutritional status. Chi-square analysis revealed statistically significant relationships between nutritional deficits and developmental outcomes across all major developmental domains (p < 0.05). Multivariable logistic regression analysis was performed to identify independent predictors of developmental delay while controlling for potential confounding variables. Stunting emerged as a strong independent predictor of developmental delay, followed by underweight and wasting. Children with anaemia were also significantly more likely to experience developmental impairment compared with non-anaemic children. In addition, low maternal educational status was independently associated with an increased likelihood of developmental delay, suggesting the influence of both biological and environmental factors on child development. The combined effects of chronic undernutrition, micronutrient deficiency, and adverse socioeconomic circumstances appeared to contribute substantially to poorer developmental outcomes. Children exposed to multiple risk factors demonstrated the highest probability of developmental delay. Overall, the findings indicate a clear and significant association between nutritional status and developmental performance, highlighting that undernourished children are at considerably greater risk of delayed achievement of developmental milestones, particularly in language and cognitive domains. These results emphasize the importance of early nutritional assessment and intervention as part of comprehensive child development programmes.
Diagnostic Accuracy of Diffusion-Weighted MRI and Apparent Diffusion Coefficient Values in Differentiating Benign and Malignant Soft-Tissue Tumours: A Prospective Histopathology-Correlated Study
Background: Accurate differentiation between benign and malignant soft-tissue tumours is essential for appropriate clinical management, biopsy planning, and treatment selection. Conventional magnetic resonance imaging (MRI) provides excellent anatomical information but has limited specificity for distinguishing tumour nature. Diffusion-weighted imaging (DWI) and apparent diffusion coefficient (ADC) measurements offer quantitative assessment of tissue cellularity and may improve diagnostic characterization. Objective: To evaluate the diagnostic performance of diffusion-weighted imaging-derived ADC values in differentiating benign from malignant soft-tissue tumours using histopathology as the reference standard. Methods: This prospective diagnostic accuracy study included 110 patients with soft-tissue masses who underwent MRI with diffusion-weighted imaging prior to biopsy or surgical excision. ADC maps were generated from DWI sequences acquired at b-values of 0, 500, and 1000 s/mm². Mean ADC values were measured from the solid tumour components while avoiding necrotic and haemorrhagic areas. Histopathological diagnosis served as the reference standard. Mean ADC values between benign and malignant lesions were compared, and receiver operating characteristic (ROC) analysis was performed to determine diagnostic accuracy and the optimal ADC threshold. Results: Among the 110 lesions evaluated, 50 (45%) were malignant and 60 (55%) were benign on histopathology. Malignant tumours demonstrated significantly lower mean ADC values than benign lesions (0.95 ± 0.22 vs. 1.55 ± 0.30 × 10⁻³ mm²/s; p < 0.001). ROC analysis showed good diagnostic performance, with an area under the curve (AUC) of 0.88. The optimal ADC threshold for differentiating malignant from benign lesions was 1.20 × 10⁻³ mm²/s. At this threshold, sensitivity was 84%, specificity was 82%, positive predictive value was 80%, and negative predictive value was 86%. ADC values below the threshold were strongly associated with malignancy. Conclusion: Diffusion-weighted imaging-derived ADC values provide valuable quantitative information for the characterization of soft-tissue tumours. Malignant lesions exhibit significantly lower ADC values than benign lesions, and ADC demonstrates good diagnostic accuracy for distinguishing between the two groups. Incorporation of DWI into routine MRI protocols may improve non-invasive tumour characterization, assist biopsy planning, and support clinical decision-making. Nevertheless, ADC should be interpreted alongside conventional MRI findings and histopathological confirmation remains essential.
Dr. Rajaram Ganesan1 Dr. Rajaram Ganesan1
Dr. Yadlapalli Sai Pramod2 Dr. Yadlapalli Sai Pramod2
Surgical Site Infection and Its Risk Factors Following Abdominal Surgery: A Hospital-Based Observational Study
Background: Surgical site infection (SSI) remains one of the most common and costly healthcare-associated infections following abdominal surgery, contributing to prolonged hospitalisation, increased morbidity, and avoidable expenditure. Reported rates are consistently higher in developing-country settings, yet contemporary data from South India are limited. This study aimed to determine the incidence of SSI following abdominal surgery and to identify associated risk factors. Methods: A hospital-based observational study was conducted among 250 patients undergoing abdominal surgery at Tertiary Care Teaching Hospital. SSI was assessed during the period of admission using the Centers for Disease Control and Prevention (CDC) criteria. Demographic, clinical, and operative variables were recorded prospectively. Descriptive statistics were computed, and associations between potential risk factors and SSI were examined using the chi-square test for categorical variables and the independent-samples t-test for continuous variables, with a significance threshold of p < 0.05. Results: The mean age of the cohort was 49.7 (SD 17.8) years, with near-equal sex distribution (female 50.8%, male 49.2%) and a mean body mass index of 28.7 (SD 5.8) kg/m². SSI occurred in 39 patients, yielding an overall rate of 15.6% (95% CI 11.1–20.1%). SSI was significantly associated with diabetes mellitus (21.8% in diabetics vs 9.9% in non-diabetics; χ² = 5.86, p = 0.015) and with prolonged operative time (>120 min, 20.4%; χ² = 8.66, p = 0.013), with a higher mean operative duration among SSI cases (169.7 vs 141.7 min; t = 3.02, p = 0.003). No significant association was observed with gender, smoking, ASA grade, antibiotic prophylaxis, BMI category, or age. Conclusion: The SSI rate of 15.6% is consistent with figures reported from comparable Indian settings. Diabetes mellitus and prolonged operative time emerged as the principal identifiable risk factors. The apparent absence of benefit from antibiotic prophylaxis most plausibly reflects confounding by indication in this observational design rather than true ineffectiveness. Glycaemic optimisation and measures to reduce operative duration may help lower the SSI burden
CLINICAL PROFILE AND QUALITY OF LIFE ASSESSMENT IN PATIENTS WITH CHRONIC URTICARIA: A CROSS-SECTIONAL STUDY
In this cross-sectional study of 120 patients with chronic urticaria, the clinical profile demonstrated a substantial burden of disease activity and impairment in daily functioning. Moderate-to-severe disease activity, as measured by the Urticaria Activity Score over seven days (UAS7), was observed in approximately two-thirds of patients, indicating that a significant proportion experienced persistent and troublesome symptoms despite routine management. Recurrent wheals were the predominant clinical manifestation, while angioedema was present in a considerable subset of patients, further contributing to disease severity and patient discomfort. Several patients reported identifiable triggering factors, including food items, environmental exposures, infections, stress, and medication-related triggers, although trigger patterns varied considerably among individuals. The autologous serum skin test (ASST), used as a marker of autoimmune involvement, was positive in a proportion of cases, supporting the role of autoimmune mechanisms in the pathogenesis of chronic urticaria for a subset of affected patients. Assessment of health-related quality of life using the Dermatology Life Quality Index (DLQI) revealed marked impairment across multiple domains, including daily activities, work productivity, social interactions, sleep quality, and emotional well-being. Many patients reported frustration, embarrassment, anxiety, and reduced confidence due to the unpredictable and recurrent nature of the disease. Statistical analysis demonstrated a moderate positive correlation between disease activity and quality-of-life impairment (r ≈ 0.55), indicating that patients with higher UAS7 scores experienced substantially greater disruption in physical, psychological, and social functioning. These findings highlight the multidimensional impact of chronic urticaria beyond its visible cutaneous manifestations and emphasize the importance of comprehensive patient assessment. Effective management should therefore incorporate not only symptom control and reduction of disease activity but also routine evaluation of quality-of-life outcomes. An individualized, patient-centred treatment approach guided by both clinical activity measures and quality-of-life assessments may improve overall disease control, treatment satisfaction, and long-term patient outcomes.
Dr. Raparla Vindhya1 Dr. Raparla Vindhya