American Journal of Forensic Psychology (ISSN: 0733-1290) Official Website: https://americanforensicpsychology.org/ is a peer-reviewed academic journal dedicated to research and professional practice in the field of forensic psychology, which explores the relationship between psychology and the legal system. The journal publishes original research, case studies, and theoretical papers related to criminal behavior, psychological assessment, legal decision-making, and mental health issues in legal contexts. Founded in 1983 and published by the American College of Forensic Psychology (ACFP), United States, the journal serves as a platform for psychologists, criminologists, legal scholars, and researchers working in applied and forensic psychology. It is indexed in international databases and is classified under Medicine (Pathology and Forensic Medicine) and Psychology (Applied Psychology). According to SCImago Journal Rank (SJR) 2024, the journal has an SJR score of 0.103, is placed in Q4, and has an H-Index of 20.
American College of Forensic Psychology (ACFP),
Efficacy of Toothbrushing in Dental Plaque Control for the Prevention of Gingivitis
Background: Dental plaque is the primary etiological factor in the development of gingivitis and remains a major cause of periodontal disease worldwide. Effective toothbrushing is the cornerstone of daily plaque control; however, its effectiveness depends on brushing frequency, duration, technique, and individual compliance. This study aimed to evaluate the efficacy of toothbrushing in dental plaque control for the prevention of gingivitis among adults aged 20–55 years. A cross-sectional study was conducted over three months among 100 participants recruited through convenience sampling from dental outpatient clinics. Dental plaque and gingival health were assessed using the Plaque Index (Silness & Löe, 1964) and the Gingival Index (Löe & Silness, 1963), while oral hygiene practices were recorded using a structured questionnaire. Data were analyzed using SPSS version 26.0, employing descriptive statistics and the Chi-square test, with statistical significance set at p < 0.05. Among the participants, 58% brushed twice daily, 66% brushed for at least two minutes, and 63% practiced a proper toothbrushing technique. Good plaque control was observed in 45% of participants, whereas 43% had healthy gingiva. Healthy gingival conditions were present in 72% of participants with good brushing habits. Participants who brushed at least twice daily demonstrated significantly better plaque control than those brushing once daily (78.6% vs. 26.7%, p = 0.001), while healthy gingiva was more common among those using a proper brushing technique than among those using an improper technique (71.4% vs. 21.6%, p = 0.001). These findings indicate that regular toothbrushing together with the use of fluoridated toothpaste significantly improves plaque control and reduces gingival inflammation. Promoting appropriate oral hygiene practices through regular oral health education may contribute to the prevention of gingivitis and improvement of periodontal health
Tooth brushing, Dental Plaque, Gingivitis, Oral Hygiene, Plaque Control, Gingival Health, Adults.
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Clinical Characteristics, Severity, and Treatment Outcomes of Alcohol Withdrawal Syndrome in Patients With Alcohol-Associated Liver Disease: A Comparative Observational Study.
Background: Aim: To evaluate and compare the clinical characteristics and treatment outcomes of alcohol withdrawal syndrome in patients with and without liver disease. Materials and Methods: This hospital-based observational comparative study was conducted in the Department of General Medicine, ESIC Medical College and Hospital, MIA, Desula, Alwar, Rajasthan. A total of 300 patients diagnosed with alcohol withdrawal syndrome were enrolled and divided into two groups: patients with liver disease [LIV(+)] and patients without liver disease [LIV(-)], with 150 patients in each group. Diagnosis of AWS was based on DSM-5 criteria and severity assessment was performed using the Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) scale. Detailed demographic, clinical, and laboratory parameters were recorded. Treatment outcomes including duration of hospital stay, ICU admission, withdrawal seizures, delirium tremens, ventilatory support, and mortality were assessed. Statistical analysis was performed using SPSS software, and p<0.05 was considered statistically significant. Results: The mean age of patients with liver disease was significantly higher compared to patients without liver disease (54.2 ± 11.8 years vs. 49.6 ± 13.4 years; p<0.05). Severe withdrawal manifestations including hallucinations, delirium tremens, and withdrawal seizures were significantly more common in the LIV(+) group. The mean peak CIWA-Ar score was significantly higher among patients with liver disease (18.2 ± 6.1 vs. 13.5 ± 5.2; p<0.001). Laboratory abnormalities such as elevated bilirubin, transaminases, hypoalbuminemia, thrombocytopenia, and prolonged coagulation profile were significantly associated with liver disease. Patients with liver disease had longer hospital stay (7.8 ± 3.4 days vs. 4.6 ± 2.1 days; p<0.001), increased ICU admission (25.7% vs. 10.0%), higher requirement for mechanical ventilation (10.0% vs. 2.9%), and greater mortality (7.9% vs. 2.1%). Conclusion: Alcohol withdrawal syndrome in patients with liver disease is associated with significantly increased clinical severity, prolonged hospitalization, higher ICU requirement, and increased mortality compared to patients without liver disease. Liver disease should be considered an important predictor of adverse outcomes in AWS. Early identification, close monitoring, individualized benzodiazepine therapy, and aggressive supportive management are essential to improve prognosis in this high-risk population.
Alcohol withdrawal syndrome; Liver disease; Alcohol-associated liver disease; CIWA-Ar; Delirium tremens; Withdrawal seizures; Intensive care unit; Mortality.
Association Between Beverage Consumption Patterns and Oral Sensitivity Among Adults in Karachi: A Cross-Sectional Study.
Background: Oral sensitivity is a typical issue that may have a negative influence on oral hygiene habits, drinking and eating. Maleficent acidic drinks have been proposed to be causative factors or factors that cause oral sensitivity due to their erosive properties on the teeth hard tissue. Nonetheless, sales of evidence on relationships between beverage habits and oral sensitivity among adults, especially in Pakistan are scarce. The purpose of conducting this study was to investigate the relationship that exists between beverage habit and oral sensitivity that is self-reported with self-reported oral sensitivity among adults in Karachi, Pakistan. Methods: A cross-sectional analytical study on 375 adult participants of 18 years and above was carried out using structured self-administered questionnaire which was administered using online resources. A non-probability convenience sampling technique was used in recruiting the participants. The data on the demographic variables, oral hygiene habits, drinking habits, and self-reported oral health outcomes were gathered. The data were summarized using descriptive statistics and chi-square test was used to determine the association between the frequency of beverage consumption and the outcome of oral health. p < 0.05 was set as the statistical significance. Results: The majority of participants were aged 18–25 years (71.7%), female (62.7%), and undergraduate students (48.8%). Acidic beverage consumption was common, with 48.3% of participants reporting consumption one to three times per week and 41.9% reporting consumption for more than five years. Self-reported tooth sensitivity was reported by 29.3% of participants, dental caries within the previous 12 months by 31.7%, and tooth erosion by 11.7%. No statistically significant associations were observed between the frequency of acidic beverage consumption and tooth sensitivity (χ² = 11.338, p = 0.183), dental caries (χ² = 2.729, p = 0.604), or tooth erosion (χ² = 13.942, p = 0.083). Conclusion: The consumption of acidic beverages was prevalent among the study group but there was no statistically significant relationship between beverage consumption frequency and self-reported oral sensitivity outcomes, dental caries or tooth erosion. Although statistically significant relationships were not detected, the prevalence of the use of acidic drinks indicates the need to encourage good nutrition and preventive dental care. It is proposed that future longitudinal studies that use objective clinical examination and multi-variable analysis can elucidate the relationship between beverage consumption patterns and oral health outcome better.
acidic drinks; drinks; Oral sensitivity; dentine hypersensitivity; periodontal caries; tooth erosion; cross-sectional research.
Awareness of Medico-Legal Responsibilities Among Interns: A Cross-Sectional Study at RIMS, Raichur.
Background: The transition from medical student to practicing doctor involves assuming significant medico-legal responsibilities. With the rising number of litigations against healthcare professionals, adequate knowledge of medical ethics and law is crucial. This study aims to assess the awareness of medico-legal responsibilities among medical interns. Methods: A descriptive cross-sectional study was conducted among 110 medical interns at the Raichur Institute of Medical Sciences (RIMS), Raichur. Data regarding their knowledge on consent, medical record maintenance, the Consumer Protection Act (CPA), and handling of medico-legal cases (MLC) was collected using a semi-structured questionnaire and analyzed. Results: Out of 110 interns, 96.4% correctly identified written informed consent as the best type of consent in MLCs. However, significant gaps were observed in practical applications, with only 30.9% confident in issuing injury certificates and 33.6% confident in issuing medical cause of death certificates. Awareness of the Consumer Protection Act (CPA) was limited (29.1%), and confidence in attending court to give testimony was notably poor. Conclusion: While baseline theoretical knowledge is present, there are significant gaps in practical application and legal awareness, highlighting the need for targeted medico-legal orientation programs before and during the internship period.
Medico-legal, Medical Interns, Awareness, Medical Ethics, Consumer Protection Act, Informed Consent.
Psychiatric Comorbidity and Suicidal Ideation Among Adults with Psoriasis: A Cross-Sectional Study.
Introduction: Psoriasis is a chronic inflammatory skin disorder frequently associated with psychological distress, impaired quality of life, and increased risk of suicidal behavior. This study was conducted to assess quality of life, psychiatric comorbidity, and suicidal ideation among patients with psoriasis and identify factors associated with suicidal ideation. Methods: A hospital-based cross-sectional study was conducted among 216 adult patients with clinically diagnosed psoriasis attending a tertiary care teaching hospital. Sociodemographic and clinical information were collected using a structured questionnaire. Disease severity was assessed using PASI, quality of life using DLQI, depression using PHQ-9, anxiety using GAD-7, and suicidal ideation using PHQ-9 item 9 and C-SSRS. Data were analysed using descriptive statistics, chi-square tests, and multivariable logistic regression. Results: Among the participants, 61.1% were male and the mean age was 40.2±12.1 years. Nearly half (49.1%) had disease duration >5 years, while scalp involvement (45.4%), nail involvement (33.3%), and topical therapy (57.4%) predominated. Moderate-to-very large impairment in quality of life was observed in 66.6% of patients. Moderate-to-severe depressive symptoms and anxiety symptoms were present in 25.0% and 16.7% of participants, respectively. Suicidal ideation was reported by 16.7% of patients; among them, 61.1% had passive ideation, 27.8% had active ideation without intent, and 11.1% had active ideation with intent or plan. Moderate-to-severe depression (aOR=5.6; 95% CI: 2.4–12.9), large/very large DLQI impairment (aOR=2.8; 95% CI: 1.3–6.2), and higher internalized stigma (aOR=1.4; 95% CI: 1.0–1.9) were independent predictors of suicidal ideation. Conclusions: Psoriasis is associated with significant impairment in quality of life, psychiatric morbidity, and suicidal ideation. Routine mental health screening and integrated dermatological and psychiatric care are essential to improve patient outcomes.
Anxiety, Depression, Psoriasis, Psychiatric comorbidity, Quality of life, Suicidal ideation.
Prevalence of Obesity and Its Association with Rate Pressure Product among the Rural Population: A Community-Based Cross-Sectional Study.
Background: Obesity is an emerging public health challenge and a major contributor to cardiovascular morbidity. Rate Pressure Product (RPP), derived from systolic blood pressure and heart rate, is a simple non-invasive indicator of myocardial oxygen demand and cardiac workload. Evidence regarding the association between obesity and RPP among the rural population remains limited. Objectives: To estimate the prevalence of obesity among the rural population using anthropometric indices and to assess its association with Rate Pressure Product. Materials and Methods: A community-based cross-sectional study was conducted among 300 adults aged ≥18 years residing in the Rural Health Practice Area of Index Medical College, Hospital and Research Centre, Indore after the approval from Institutional Ethical Committee (IEC/IMCHRC/2024/45). Participants were selected using a multistage random sampling technique from 10 randomly selected villages. A pre-tested semi-structured questionnaire was used to collect socio-demographic and clinical information. Anthropometric measurements including body mass index (BMI), waist circumference, and waist-hip ratio were recorded using standard procedures. Blood pressure and heart rate were measured under standardized conditions, and Rate Pressure Product was calculated as systolic blood pressure × heart rate. Data were analyzed using appropriate descriptive and inferential statistical tests, with p<0.05 considered statistically significant. Results: Among the 300 study participants, 21% were obese, 8% were overweight, and 62% had normal BMI. Increased waist-hip ratio suggestive of central obesity was observed in 42% of participants. Obese individuals had significantly higher systolic blood pressure, diastolic blood pressure, heart rate, and Rate Pressure Product than non-obese individuals (p<0.001). The prevalence of elevated RPP (≥7000) was 34% overall and increased substantially among obese participants. Positive associations were observed between obesity-related anthropometric indices and Rate Pressure Product. Conclusion: Obesity was common among the rural population and was significantly associated with increased Rate Pressure Product, indicating greater myocardial workload. Simple anthropometric assessment along with RPP estimation may be useful for early identification of individuals at increased cardiovascular risk in community settings.
Obesity, Rate Pressure Product, Body Mass Index, Anthropometric Indices, Rural Population, Cardiovascular Risk.
Comparative Evaluation of Laparoscopic Versus Open Appendectomy in Adult Patients with Acute Appendicitis: A Prospective Comparative Study of Surgical Outcomes and Recovery.
Background: Acute appendicitis remains one of the most common surgical emergencies encountered in general surgical practice worldwide, with a lifetime prevalence of approximately 7–8%. Although laparoscopic appendectomy (LA) has progressively gained acceptance since its introduction, the debate regarding its superiority over conventional open appendectomy (OA), particularly in resource-limited settings, continues, with mixed evidence regarding operative time, cost, and post-operative recovery. Objectives: To prospectively compare the intraoperative parameters, post-operative pain, recovery indices, morbidity, and short-term outcomes of laparoscopic versus open appendectomy in adult patients with acute appendicitis at a tertiary care teaching hospital. Materials and Methods: A hospital-based prospective comparative study was conducted in the Department of General Surgery, Sapthagiri Institute of Medical Sciences and Research Centre (SIMSRC), Chikkabanavara, Bengaluru – 560090, Karnataka, India, from 22 February 2026 to 22 May 2026. A total of 46 adult patients (aged ≥18 years) with a clinical and radiological diagnosis of acute appendicitis were allocated by simple randomization into two equal groups of 23 patients each: Group A (laparoscopic appendectomy) and Group B (open appendectomy). Outcome parameters recorded included operative time, intraoperative blood loss, post-operative pain (Visual Analogue Scale), time to oral intake, time to ambulation, length of hospital stay, complications, return to work, cosmetic satisfaction, and hospitalization cost. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 22.0; a p-value < 0.05 was considered statistically significant. Results: The two groups were comparable in age, gender, body mass index, and Alvarado score at presentation (p > 0.05). Mean operative time was significantly longer in Group A (62.5 ± 12.4 minutes) than in Group B (48.3 ± 10.7 minutes; p < 0.001), whereas mean intraoperative blood loss was significantly less in Group A (18.6 ± 6.2 mL vs 42.5 ± 13.8 mL; p < 0.001). Post-operative VAS pain scores were consistently lower in Group A at 6, 24, 48, and 72 hours (p < 0.001). Mean length of hospital stay (3.1 ± 0.8 vs 5.2 ± 1.4 days; p < 0.001) and mean time to return to work (12.4 ± 3.2 vs 21.6 ± 5.7 days; p < 0.001) were both significantly shorter following LA. The overall post-operative complication rate was 17.4% in Group A compared with 34.8% in Group B, largely driven by a lower incidence of surgical site infection in the LA group (8.7% vs 26.1%). Cosmetic satisfaction at three months was significantly higher after LA (8.6 ± 0.9 vs 6.2 ± 1.3; p < 0.001), although the total hospitalization cost was higher (₹32,500 ± ₹4,200 vs ₹22,800 ± ₹3,500; p < 0.001). Conclusion: Laparoscopic appendectomy offers demonstrable advantages over open appendectomy in adults with acute appendicitis, including less post-operative pain, faster recovery, shorter hospital stay, earlier return to work, fewer wound-related complications, and superior cosmetic outcomes, despite a longer operative time and higher immediate cost. Wider adoption of the laparoscopic technique is recommended wherever expertise and infrastructure permit, and cost-offsetting through shorter hospitalization and earlier return to productivity should be considered when comparing the two approaches.
Acute appendicitis; Laparoscopic appendectomy; Open appendectomy; Surgical site infection; Post-operative recovery; Visual Analogue Scale.
Evaluation of Chronic Postoperative Groin Pain After Inguinal Hernia Repair: A Comparative Study of Open and Laparoscopic Surgical Techniques.
Background: Chronic postoperative groin pain (CPGP), defined as pain persisting beyond three months following inguinal hernia repair, is now recognised as the most clinically significant long-term complication of this common operation. Its incidence and severity may vary substantially between open and laparoscopic surgical approaches, but comparative data from Indian tertiary-care centres remain limited. Aim: To evaluate and compare the incidence, severity and functional impact of chronic postoperative groin pain in patients undergoing open Lichtenstein tension-free mesh repair versus laparoscopic total extraperitoneal (TEP) repair for uncomplicated primary inguinal hernia. Materials and Methods: This prospective, non-randomised, comparative observational study was conducted at the Department of General Surgery, The Oxford Medical College Hospital and Research Centre, Bangalore, between 22 February 2026 and 22 May 2026. Forty-five adult patients with uncomplicated unilateral primary inguinal hernia were allocated to either open Lichtenstein repair (Group A, n = 23) or laparoscopic TEP repair (Group B, n = 22) based on surgeon preference and patient choice after informed consent. Pain was assessed using the Visual Analog Scale (VAS) and the Inguinal Pain Questionnaire (IPQ) at 24 hours, one week, one month and three months postoperatively. Perioperative variables, complications and return-to-work interval were recorded. Statistical analysis was performed using SPSS v26.0; p < 0.05 was considered significant. Results: Both groups were comparable at baseline (p > 0.05). Mean VAS scores were significantly lower in the laparoscopic group at every time point: 24 h (4.1 ± 1.2 vs 6.2 ± 1.4, p < 0.001), one week (2.2 ± 0.9 vs 3.8 ± 1.1, p < 0.001), one month (1.3 ± 0.7 vs 2.1 ± 1.0, p = 0.003) and three months (0.7 ± 0.8 vs 1.4 ± 1.2, p = 0.021). At three months, CPGP of any severity was reported by 9/23 (39.1 %) in the open group versus 5/22 (22.7 %) in the laparoscopic group (p = 0.234); moderate-to-severe pain (VAS ≥ 4) occurred in 3/23 (13.0 %) versus 1/22 (4.5 %) respectively. Mean operative time was longer in the laparoscopic group (78.4 ± 15.7 vs 62.5 ± 12.3 min, p < 0.001), whereas hospital stay (1.6 ± 0.6 vs 2.8 ± 0.9 days, p < 0.001) and return to work (9.4 ± 3.1 vs 18.2 ± 4.5 days, p < 0.001) were significantly shorter. Complication rates were comparable. Conclusion: Laparoscopic TEP repair was associated with a lower mean intensity of chronic postoperative groin pain, faster convalescence and earlier return to work compared with open Lichtenstein repair, although the difference in overall CPGP incidence did not reach statistical significance in this small cohort. Larger multicentric randomised trials are warranted to consolidate these findings.
Chronic postoperative groin pain; Inguinal hernia; Lichtenstein repair; Laparoscopic hernia repair; TEP; Visual Analog Scale; Inguinodynia
Clinical Profile, Surgical Management, and Predictors of Mortality Among Patients with Blunt Abdominal Trauma Undergoing Emergency Laparotomy: A Prospective Study.
Background: Blunt abdominal trauma (BAT) is an important cause of morbidity and mortality among trauma victims in low- and middle-income settings, where road traffic accidents dominate the injury landscape. Timely identification of patients who require emergency laparotomy and recognition of factors that predict adverse outcome remain central to surgical decision-making. Objectives: To describe the clinical profile, spectrum of intra-abdominal injuries, and operative management of patients undergoing emergency laparotomy for BAT, and to identify pre-operative and intra-operative predictors of in-hospital mortality. Methods: A prospective observational study was conducted in the Department of General Surgery, FAME Hospital and Research Institute, Mysore, over a two-month period (15 March 2026 to 15 May 2026). Forty-five consecutive adult patients (≥18 years) who underwent emergency exploratory laparotomy for BAT were enrolled after informed consent. Demographic details, mechanism of injury, admission Glasgow Coma Scale (GCS), systolic blood pressure (SBP), Focused Assessment with Sonography for Trauma (FAST) and contrast-enhanced computed tomography (CECT) findings, Injury Severity Score (ISS), operative findings, procedures performed, transfusion requirements, complications, and 30-day outcomes were recorded on a structured proforma. Data were analysed with SPSS v.25.0 using the χ² test, Fisher exact test, Student t test, Mann–Whitney U test, and stepwise multivariable logistic regression; P < 0.05 was considered significant. Results: The mean age was 34.6 ± 12.8 years and 36 (80.0 %) were male. Road traffic accident was the leading mechanism (28/45, 62.2 %). At presentation, 17 patients (37.8 %) had systolic hypotension (SBP < 90 mm Hg) and 7 (15.6 %) had a GCS ≤ 8. FAST was positive in 39 patients (86.7 %). The spleen (17, 37.8 %), small bowel (14, 31.1 %), and liver (12, 26.7 %) were the most commonly injured organs; 22 patients (48.9 %) had injury to more than one intra-abdominal organ. Splenectomy was performed in 12 patients (26.7 %) and primary bowel repair or resection–anastomosis in 15 (33.3 %). Damage-control laparotomy was employed in 6 patients (13.3 %). Postoperative morbidity occurred in 22 patients (48.9 %); surgical site infection (12, 26.7 %) and pneumonia (7, 15.6 %) were the commonest complications. Overall in-hospital mortality was 17.8 % (8/45). On univariate analysis, admission SBP < 90 mm Hg, GCS ≤ 8, ISS > 25, ≥ 3 organs injured, need for massive transfusion, and time from injury to operation > 6 hours were significantly associated with death. On multivariable logistic regression, admission SBP < 90 mm Hg (adjusted OR 9.4; 95 % CI 1.8–48.7; P = 0.007) and ISS > 25 (adjusted OR 11.2; 95 % CI 2.0–63.4; P = 0.006) remained independent predictors of mortality. Conclusion: Young men injured in road traffic accidents accounted for the bulk of BAT requiring emergency laparotomy at our centre. The spleen and small bowel were the most frequently injured organs. Admission haemodynamic instability, a low GCS, high Injury Severity Score, and delay to definitive operation were closely associated with mortality; among these, haemodynamic status at arrival and overall injury burden emerged as independent predictors. Streamlined pre-hospital transfer, early damage-control resuscitation, and prompt operative intervention are essential to improve survival.
blunt abdominal trauma; emergency laparotomy; mortality predictors; Injury Severity Score; damage-control surgery.
Effect of a Theory-Based Nurse-Led Behaviour Change Intervention on Psychosocial Determinants and Uptake of VIA Cervical Cancer Screening Among Women Aged 30–49 Years: A Randomized Controlled Trial
Background: India accounts for nearly a quarter of global cervical cancer deaths, yet only a small minority of women aged 30–49 years have ever been screened. Visual Inspection with Acetic Acid (VIA) is effective and widely available, making screening uptake rather than service availability the binding constraint. We evaluated whether a theory-based, nurse-led behaviour change intervention could increase VIA screening uptake and improve its psychosocial determinants. Methods: A parallel-group, two-arm randomized controlled trial was conducted in the rural and urban health training centre catchment areas of a medical college hospital in Indore, India. Three hundred women aged 30–49 years, not screened in the preceding three years, were randomized 1:1 using computer-generated random numbers with allocation concealment by sequentially numbered opaque sealed envelopes. The intervention comprised five nurse-delivered sessions over 4–6 weeks, grounded in the Health Belief Model (HBM) and COM-B framework, covering cervical cancer education, VIA and its benefits, barrier problem-solving, motivational interviewing with action planning, and reinforcement with appointment finalization. Controls received routine health education. The primary outcome was VIA screening uptake at 3 and 6 months, verified through screening registers. Secondary outcomes were knowledge, the six HBM constructs, and satisfaction. Analysis was by intention to treat with multiple imputation for missing data. Results: Groups were comparable at baseline across all socio-demographic, reproductive, knowledge, and belief measures (all p > 0.05); overall attrition was 10.7%. VIA screening uptake was significantly higher in the intervention arm at 3 months (30.0% vs 12.0%; difference 18.0%, 95% CI 8.8–27.2; p < 0.001) and at 6 months (36.0% vs 16.0%; difference 20.0%, 95% CI 10.3–29.7; p < 0.001). After adjustment for age, education, income, parity, baseline knowledge, and baseline self-efficacy, allocation to the intervention remained the strongest independent predictor of uptake (adjusted OR 3.02, 95% CI 1.68–5.43, p < 0.001). Knowledge rose from 8.6 ± 3.2 to 19.4 ± 2.8 out of 25 immediately post-intervention and remained at 18.1 ± 3.0 at 6 months versus 9.8 ± 3.2 in controls (p < 0.001). All six HBM constructs improved significantly, with the largest gains in perceived benefits and self-efficacy (+1.1 each) and a marked fall in perceived barriers (−0.9); group × time interactions were significant for every construct (p < 0.001). Overall satisfaction was 91.2%, and 95.6% would recommend the programme. Conclusion: A structured, theory-based, nurse-led counselling intervention more than doubled verified VIA screening uptake and produced broad, sustained improvements in the psychosocial determinants of screening behaviour. The approach is acceptable and replicable, and merits integration into community-based cervical screening programmes.
cervical cancer screening; visual inspection with acetic acid; nurse-led intervention; Health Belief Model; COM-B; randomized controlled trial; India.
Factors Influencing Morbidity and Mortality Following Emergency Surgery for Perforated Peptic Ulcer Disease: A Prospective Observational Study.
Background: Perforated peptic ulcer disease (PPUD) remains one of the most lethal surgical emergencies encountered in general surgical practice, with reported mortality rates ranging between 10% and 25%. Identification of modifiable and non-modifiable prognostic determinants is essential for risk stratification and improvement of postoperative outcomes. Objectives: To determine the incidence, clinical spectrum, and postoperative outcomes of PPUD, and to identify preoperative and intraoperative variables independently associated with postoperative morbidity and mortality. Methods: A prospective observational study was conducted at the Department of General Surgery, Sapthagiri Institute of Medical Sciences and Research Centre (SIMSRC), Chikkabanavara, Bengaluru, over a two-month period from 28 April 2026 to 30 June 2026. Forty-five consecutive patients aged ≥18 years diagnosed with perforated peptic ulcer and undergoing emergency laparotomy were enrolled. Demographic, clinical, biochemical, operative, and outcome variables were recorded. The Boey score and ASA physical status were used for preoperative risk stratification. Data were analysed using SPSS version 26.0; the chi-square test, Fisher’s exact test, Student’s t-test, and multivariable logistic regression were applied, with a p-value <0.05 considered statistically significant. Results: The mean age of the cohort was 48.5 ± 14.2 years, with a marked male preponderance (84.4%). Duodenal perforation accounted for 77.8% of cases, and Graham’s omentopexy was the predominant procedure (86.7%). Overall morbidity was 40.0% (18/45) and mortality was 11.1% (5/45). Surgical site infection (26.7%) was the most frequent complication. On univariate analysis, age >60 years (p=0.021), delayed presentation beyond 24 hours (p=0.008), preoperative shock (p<0.001), Boey score ≥2 (p<0.001), ASA grade ≥III (p=0.003), serum albumin <2.5 g/dL (p=0.014), and perforation size >10 mm (p=0.019) were significantly associated with adverse outcomes. On multivariable logistic regression, preoperative shock (adjusted OR 8.6; 95% CI 1.8–41.2; p=0.007) and Boey score ≥2 (adjusted OR 6.4; 95% CI 1.5–27.9; p=0.013) remained independent predictors of mortality. Conclusion: Timely referral, aggressive resuscitation, and early operative intervention remain the cornerstones of management in PPUD. The Boey score and ASA grade are simple, reliable tools that identify high-risk patients likely to benefit from intensive perioperative care
Perforated peptic ulcer; peritonitis; Boey score; ASA grade; Graham’s omentopexy; emergency laparotomy; morbidity; mortality
Evaluating the Need for Dedicated Medico-Legal Units in Indian Hospitals: A Stakeholder Perspective from General Hospital, Palanpur
Introduction: Medico-legal case (MLC) management is integral to healthcare and justice delivery. In India, a lack of structured medico-legal units (MLUs) often leads to inefficient documentation and coordination. Aim: To evaluate the need for dedicated MLUs in Indian hospitals based on stakeholder perspectives. Methodology: A cross-sectional survey of 42 healthcare providers and 7 administrators was conducted at General Hospital, Palanpur, using a structured questionnaire. Data were analysed descriptively. Results: Most respondents cited inadequate resources (72%) and overburdened staff (65%) as major issues; 60% reported documentation delays. Eighty-nine percent supported the creation of MLUs to improve documentation (85%) and coordination (90%). Conclusion: Stakeholders strongly support dedicated MLUs to improve medico-legal efficiency, but financial constraints and training needs must be addressed.
Medico-legal units, forensic medicine, hospital administration, India.
Nipah Virus Encephalitis and the Medico Legal Brain: Neuropathology, Neurobehavioural Sequelae, Capacity, and One Health Forensics
Background: Nipah virus encephalitis is a highly lethal zoonotic infection capable of producing acute cerebral dysfunction, delayed neurological disease, and persistent neurobehavioural impairment; however, its implications for legal capacity, forensic pathology, and One Health investigation remain poorly integrated.A scoping review was conducted according to JBI methodology and reported it in accordance with PRISMA ScR. MEDLINE, Embase, Scopus, Web of Science, APA PsycINFO, CINAHL, Global Health, CAB Abstracts, WHO Global Index Medicus, the Cochrane Library, and relevant grey literature sources were searched from inception through July 2026. Of 624 records identified, 146 duplicates were removed, 478 titles and abstracts were screened, 77 full texts were assessed, and 15 primary studies were included. Methodological quality was evaluated with design specific JBI instruments, the SYRCLE tool for animal studies, and AMSTAR 2 for systematic reviews. The evidence showed that Nipah virus encephalitis involves a combined neurovascular and neurotropic process characterized by endothelial infection, necrotizing vasculitis, thrombosis, microinfarction, parenchymal necrosis, and direct neuronal involvement. Acute disease was associated with altered consciousness, seizures, focal deficits, brainstem dysfunction, and high mortality. Survivors exhibited persistent fatigue, memory and attentional deficits, depression, personality change, behavioural disturbance, impaired mobility, and reduced functional independence; relapsed or late onset encephalitis was documented after apparent recovery. Outbreak investigations further demonstrated occupational, household, caregiving, and health care associated transmission, emphasizing the forensic importance of exposure reconstruction, molecular confirmation, infection control, and evidentiary continuity. No included study directly assessed decisional, testamentary, financial, or criminal capacity. The evidence was limited by small and overlapping cohorts, retrospective designs, inconsistent neuropsychological assessment, incomplete premorbid data, and sparse lesion specific behavioural correlation. Nipah virus may injure neural systems governing memory, judgement, behaviour, and autonomy; nevertheless, neuropathology establishes a biological substrate, not a legal conclusion. Medico legal attribution must remain individual, time specific, function specific, and supported by convergent clinical, cognitive, imaging, pathological, and collateral evidence.
Encephalitis, Viral; Forensic Medicine; Henipavirus Infections; Mental Competency; Neurobehavioral Manifestations; Neuropathology; Neuropsychology; Nipah Virus; One Health
IMPACT OF SOCIAL MEDIA ADDICTION ON ANXIETY AND SLEEP DISTURBANCES IN PATIENTS WITH DEPRESSION
Background: Excessive social media use has emerged as an important behavioral concern associated with adverse mental health outcomes, particularly anxiety and sleep disturbances. However, evidence regarding its impact among adults with clinically diagnosed depression remains limited. Objective: To evaluate the association between social media addiction, anxiety severity, and sleep disturbances among patients with depressive episodes. Materials and Methods: This hospital-based cross-sectional observational study included 48 adults (18–45 years) diagnosed with depressive episodes (ICD-10 F32). Daily social media use was recorded in hours, anxiety was assessed using the Generalized Anxiety Disorder-7 (GAD-7) scale, and sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI). Pearson's correlation, one-way ANOVA, and multiple linear regression analyses were performed, with statistical significance set at p<0.05. Results: Participants had a mean age of 28.9±8.2 years, and 54.2% were female. The mean daily social media use was 6.31±3.19 hours, mean GAD-7 score was 11.79±5.06, and mean PSQI score was 11.08±4.85. Daily social media use showed strong positive correlations with anxiety (r=0.993, p<0.001) and poor sleep quality (r=0.990, p<0.001). Anxiety was also strongly correlated with sleep disturbance (r=0.992, p<0.001). Patients with severe depression had significantly greater social media use, higher anxiety scores, and poorer sleep quality than those with mild or moderate depression (p<0.001). Multiple linear regression demonstrated that both daily social media use (β=0.472, p=0.049) and anxiety (β=0.656, p<0.001) independently predicted poor sleep quality, explaining 98.5% of the variance in PSQI scores. Conclusion: Excessive social media use is strongly associated with increased anxiety and impaired sleep quality in adults with depression. Social media use independently predicts sleep disturbances beyond the effects of anxiety, suggesting that assessment and management of problematic social media use should be incorporated into comprehensive psychiatric care for patients with depressive disorders.
Social media addiction, Depression, Anxiety, Sleep quality, Pittsburgh Sleep Quality Index (PSQI), Generalized Anxiety Disorder-7 (GAD-7).
Association Between Preoperative Anxiety Scores and Postoperative Pain Severity in Elective Surgical Patients: A Systematic Review
Background: Preoperative anxiety is common among patients undergoing elective surgery and may influence postoperative pain intensity, analgesic requirements, recovery, and patient satisfaction. However, the reported association varies because of differences in anxiety-assessment instruments, surgical procedures, anaesthetic techniques, analgesic protocols, and postoperative pain-assessment intervals. Objective: To systematically evaluate the association between validated preoperative anxiety scores and postoperative pain severity among adults undergoing elective surgery. Methods: This systematic review was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. MEDLINE/PubMed, Embase, Scopus, Web of Science, PsycINFO, and the Cochrane Library were searched from database inception to 30 January 2026. Eligible studies included adults undergoing elective surgery, assessed anxiety before anaesthesia using a validated instrument, measured postoperative pain using a recognised pain scale, and evaluated the association between anxiety and pain severity or analgesic use. Two reviewers independently screened records, extracted data, and assessed methodological quality using the Quality in Prognosis Studies tool. Owing to substantial clinical and methodological heterogeneity, findings were synthesised narratively. Results: The search identified 504 records. After removal of 137 duplicates, 367 records underwent title and abstract screening, and 58 full-text reports were assessed for eligibility. Forty-one reports were excluded, leaving 17 primary observational studies for qualitative synthesis. Fourteen studies reported that higher preoperative anxiety was associated with at least one adverse postoperative pain-related outcome, including greater early pain intensity, increased opioid or rescue-analgesia requirements, or a higher occurrence of moderate-to-severe pain. The association was most consistent during the first 12–24 postoperative hours. State anxiety demonstrated a clearer relationship with acute postoperative pain and analgesic use than trait anxiety. In several studies, however, the association weakened after adjustment for expected pain, catastrophising, depression, baseline pain, surgical severity, anaesthetic technique, or analgesic regimen. Five studies had a low overall risk of bias, nine had a moderate risk, and three had a high risk. Conclusion: Higher preoperative anxiety is frequently associated with greater acute postoperative pain severity and increased analgesic requirements among adults undergoing elective surgery. The relationship appears strongest during the early postoperative period and is more consistent for state anxiety than for trait anxiety. Preoperative anxiety should be considered as part of a broader biopsychosocial pain-risk assessment. Routine screening may help identify patients who could benefit from targeted counselling, psychological preparation, closer postoperative monitoring, and individualised multimodal analgesia.
preoperative anxiety; postoperative pain; elective surgery; pain severity; analgesic consumption; state anxiety; trait anxiety; systematic review.
Histopathological Spectrum of Cardiac Lesions in Sudden Death: An Autopsy-Based Study from the Mahakaushal Region of Central India
Background: Sudden cardiac death (SCD) is a major global public health problem and constitutes a large proportion of medicolegal autopsies. In India, data from semi-rural regions remain limited, and many cardiovascular pathologies go undiagnosed during life. Objectives: To evaluate the histopathological spectrum of cardiac lesions in sudden deaths, assess age- and sex-wise distribution, and correlate gross and microscopic cardiac findings. Methods: This autopsy-based observational study was conducted on sudden death cases received at a tertiary care center in the Mahakaushal region of Madhya Pradesh, India. Hearts were examined grossly and sampled systematically from the left ventricle, interventricular septum, right ventricle, and coronary arteries. Histopathological evaluation was performed using hematoxylin and eosin staining. Results: Cardiovascular pathology was identified in the majority of sudden deaths, with ischemic heart disease and coronary atherosclerosis being the predominant findings. The left anterior descending artery was most frequently involved. Acute myocardial infarction showed coagulative necrosis, wavy fibers, edema, and neutrophilic infiltration, while chronic ischemic injury was characterized by fibrosis and collagen scar formation. Males in the 41–60-year age group were most commonly affected. Gross findings such as cardiomegaly, left ventricular hypertrophy, and coronary stenosis showed strong correlation with histopathological abnormalities. Conclusion: Coronary atherosclerosis and myocardial ischemic injury are the leading histopathological substrates of sudden cardiac death in the Mahakaushal region. Autopsy with detailed microscopic examination remains indispensable for accurate cause-of-death determination and for identifying silent cardiovascular disease in the community.
Sudden cardiac death; autopsy; histopathology; coronary artery disease; myocardial infarction; atherosclerosis; Mahakaushal; India
Association of Glycemic Status, Lipid Profile, Smoking, and Occupational Exposure with Microbiologically Confirmed Pulmonary Tuberculosis: A Prospective Observational Study
Background: Tuberculosis (TB) continues to be a major public health concern, particularly in low- and middle-income countries. Metabolic disorders such as diabetes mellitus and dyslipidemia, along with smoking and occupational exposure, may increase susceptibility to active TB; however, their combined association has not been fully elucidated. Objectives: To evaluate the association of HbA1c, lipid profile, smoking history, and occupational exposure with microbiologically confirmed pulmonary TB in adults attending a tertiary care teaching hospital. Methods: This prospective observational study included 153 adults (20–60 years) with clinically suspected pulmonary TB. Diagnosis was confirmed by Ziehl–Neelsen smear microscopy, GeneXpert MTB/RIF assay, and culture where indicated. Fasting HbA1c and lipid profile were measured using standardized laboratory methods. Associations between clinical variables and confirmed TB were analyzed using univariate and multivariate logistic regression. Results: Pulmonary TB was microbiologically confirmed in 29 (19.0%) participants. Compared with TB-negative individuals, TB patients had significantly higher HbA1c (6.8±1.4 vs. 5.6±0.9%), total cholesterol, triglycerides, and LDL-cholesterol, with lower HDL-cholesterol (all p<0.01). Smoking history (62.1% vs. 33.9%; p=0.006) and high-risk occupation (48.3% vs. 25.0%; p=0.015) were also significantly more common among TB-positive participants. Multivariate analysis identified HbA1c ≥6.5% (adjusted OR 3.2), triglycerides ≥150 mg/dL (adjusted OR 2.4), smoking (adjusted OR 3.8), and high-risk occupation (adjusted OR 2.9) as independent predictors of pulmonary TB. Conclusions: Poor glycemic control, dyslipidemia, smoking, and occupational exposure are independently associated with microbiologically confirmed pulmonary TB. Integrating metabolic assessment and behavioral risk-factor screening into routine TB evaluation may improve early diagnosis and support comprehensive TB control strategies in high-burden settings.
Pulmonary tuberculosis; HbA1c; Dyslipidemia; Lipid profile; Diabetes mellitus; Smoking; Occupational exposure; GeneXpert; Biomarkers.
Effect of Hypothermia Physiology on Drug Metabolism and Toxicity in Forensic Cases: A Narrative Scoping Review and Interpretive Framework
Background: Background: Hypothermia is a clinically and forensically important physiological state in which reduced core body temperature alters cardiovascular function, hepatic enzyme activity, renal clearance, tissue perfusion, protein binding, and central nervous system responsiveness. In forensic cases, these changes may modify both the actual toxicity of drugs during life and the interpretation of postmortem drug concentrations after death. Aim: To evaluate the effect of hypothermia physiology on drug metabolism, drug toxicity, and postmortem toxicological interpretation in forensic cases, with emphasis on mechanisms relevant to alcohol, sedatives, opioids, antidepressants, antipsychotics, cardiovascular drugs, and polypharmacy. Methodology: A narrative scoping review was conducted using published literature from forensic toxicology, clinical pharmacokinetics, targeted temperature management, accidental hypothermia, postmortem redistribution, and drug-related death interpretation. Evidence was synthesized into mechanistic domains: absorption, distribution, metabolism, excretion, pharmacodynamic sensitivity, postmortem redistribution, and forensic interpretation. The results are presented as seven structured tables with interpretive inferences. Results: Hypothermia reduces hepatic enzymatic metabolism, particularly temperature-dependent cytochrome P450-mediated biotransformation; decreases hepatic and renal blood flow; delays gastrointestinal absorption; alters protein binding and tissue distribution; and increases pharmacodynamic vulnerability to central nervous system and respiratory depressants. These effects are especially important for opioids, benzodiazepines, sedative-hypnotics, antidepressants, antipsychotics, ethanol, and drugs with narrow therapeutic indices. Postmortem interpretation is complicated by redistribution, sampling-site variability, impaired premortem metabolism, delayed clearance, decomposition, and overlap between hypothermia biomarkers and drug or ethanol effects. Conclusion: Hypothermia should be considered an active modifier of drug toxicity rather than a passive background condition. In forensic cases, a drug concentration that appears therapeutic or borderline toxic under normothermic assumptions may become lethal in the presence of hypothermia-induced metabolic suppression, impaired clearance, altered consciousness, and respiratory depression. Interpretation should integrate scene findings, core-temperature history where available, autopsy findings, vitreous biochemistry, peripheral blood toxicology, drug class, tolerance, comorbidity, and postmortem interval.
Hypothermia; forensic toxicology; drug metabolism; postmortem redistribution; cytochrome P450; drug toxicity; ethanol; opioids; benzodiazepines; accidental death.
Role of Catecholamine Surge and Physiological Stress Response in Sudden Cardiac Death During Assault: A Narrative Review and Forensic Synthesis
Background: Sudden cardiac death during or shortly after assault presents a difficult medico-legal problem. In some cases, death is explained by direct trauma, commotio cordis, asphyxia, intoxication, or pre-existing heart disease. In others, the physical and psychological stress of assault may precipitate a fatal cardiac event through acute sympathetic activation, catecholamine surge, myocardial oxygen demand–supply mismatch, coronary vasospasm, stress cardiomyopathy, or malignant arrhythmia. Objective: To review the role of catecholamine surge and physiological stress response in sudden cardiac death during assault and to synthesize current evidence into a practical forensic framework. Methodology: A narrative literature review was conducted using studies, reviews, forensic case reports, registry analyses, and medico-legal discussions published up to 2026. Search themes included “sudden cardiac death,” “assault,” “catecholamine surge,” “physiological stress,” “Takotsubo syndrome,” “commotio cordis,” “post-mortem catecholamines,” “restraint death,” and “forensic pathology.” Evidence was grouped into mechanistic pathways, assault-related triggers, vulnerable cardiac substrates, forensic markers, and interpretive cautions. Results: The evidence supports a biologically plausible link between assault-related acute stress and sudden cardiac death, especially in individuals with coronary atherosclerosis, myocardial fibrosis, cardiomyopathy, channelopathy, stimulant exposure, or hypertensive heart disease. Catecholamine excess may precipitate ventricular arrhythmia, coronary vasospasm, plaque rupture, stress cardiomyopathy, and myocardial contraction-band necrosis. However, catecholamine surge is rarely sufficient as a stand-alone cause of death and must be interpreted alongside injuries, toxicology, scene evidence, resuscitation records, histology, and molecular testing. Seven synthesis tables are presented to organize mechanisms, evidence, differential diagnosis, and forensic interpretation. Conclusion: Assault can act as a trigger for sudden cardiac death through adrenergic and physiological stress pathways. The strongest conclusion is usually not that “stress alone caused death,” but that assault-related stress contributed to a fatal cardiac event in a vulnerable individual. A defensible forensic opinion requires exclusion of direct traumatic, asphyxial, toxicological, and natural causes, and careful assessment of the temporal relationship between assault and collapse.
sudden cardiac death; assault; catecholamine surge; physiological stress; ventricular arrhythmia; Takotsubo syndrome; commotio cordis; forensic pathology; restraint death.
Prevalence and Determinants of Post-Traumatic Stress Disorder Among Survivors of Sexual Assault Undergoing Forensic Evaluation: A Systematic Review
Background: Sexual assault is a severe interpersonal trauma associated with substantial psychological morbidity. Survivors who present for forensic evaluation are often assessed during the acute or early post-assault period, when distress, fear, shame, dissociation, sleep disturbance, hyperarousal, and intrusive memories may be prominent. Post-traumatic stress disorder (PTSD) is one of the most frequently reported psychiatric outcomes following sexual assault, and early identification of high-risk survivors during forensic evaluation may improve referral, follow-up, and trauma-informed care. Objective: This systematic review aimed to synthesize evidence on the prevalence and determinants of PTSD among survivors of sexual assault undergoing forensic or medico-legal evaluation. Materials and Methods: A systematic literature search was conducted using PubMed, Scopus, Web of Science, Embase, PsycINFO, Google Scholar, and manual reference screening. Search terms included “sexual assault,” “rape,” “sexual violence,” “forensic examination,” “forensic evaluation,” “sexual assault nurse examiner,” “medico-legal examination,” “post-traumatic stress disorder,” “PTSD,” “prevalence,” “risk factors,” and “determinants.” Studies were included if they reported PTSD, post-traumatic stress symptoms, or clinically significant trauma symptoms among sexual assault survivors assessed in forensic, medico-legal, emergency, or sexual assault referral settings. Reviews, commentaries, treatment-only studies, and studies without extractable PTSD-related data were excluded. Because studies varied in design, timing of assessment, PTSD tools, and population characteristics, a narrative synthesis was performed. Results: The evidence consistently showed a high burden of PTSD and post-traumatic stress symptoms among sexual assault survivors. Previous meta-analytic evidence indicates that PTSD symptoms are very common in the first year after sexual assault, with approximately three-quarters of survivors meeting PTSD criteria at one month and a substantial proportion continuing to meet criteria at one year. PTSD risk was influenced by assault severity, repeated victimization, physical injury, perceived life threat, prior trauma, childhood adversity, prior mental disorder, low social support, self-blame, shame, delayed disclosure, and negative responses from family, professionals, or legal systems. Forensic evaluation may represent a critical contact point for trauma-informed screening and referral. Conclusion: PTSD is highly prevalent among survivors of sexual assault, including those presenting for forensic evaluation. Determinants are multifactorial and include assault-related, survivor-related, psychosocial, and service-related factors. Forensic and medico-legal services should integrate trauma-informed assessment, psychological first aid, risk screening, safety planning, and referral pathways into routine care.
Sexual assault; rape; post-traumatic stress disorder; PTSD; forensic evaluation; medico-legal examination; sexual assault nurse examiner; prevalence; determinants; systematic review
Post-Traumatic Stress Disorder Among Sexual Assault Survivors Undergoing Forensic Evaluation: A Systematic Review
Background: Sexual assault is a severe traumatic event associated with long-term psychological consequences, including post-traumatic stress disorder (PTSD), depression, anxiety, self-harm, substance use, and impaired social functioning. Survivors undergoing forensic evaluation represent a particularly vulnerable group because medico-legal examination may occur soon after the assault and may be accompanied by distress, fear, stigma, shame, and concerns related to legal proceedings. Objective: This systematic review aimed to evaluate the prevalence and determinants of PTSD among survivors of sexual assault undergoing forensic or medico-legal evaluation. Materials and Methods: A systematic literature search was conducted using PubMed/MEDLINE, Scopus, Web of Science, Embase, PsycINFO, Google Scholar, and manual reference screening. Studies reporting PTSD, post-traumatic stress symptoms, or trauma-related psychological morbidity among survivors of sexual assault assessed in forensic, medico-legal, emergency, sexual assault referral, or crisis evaluation settings were included. Observational studies, cross-sectional studies, cohort studies, and forensic clinic-based studies were considered. Reviews, editorials, case reports, studies not involving sexual assault survivors, and studies without extractable PTSD-related data were excluded. Data were synthesized descriptively because of heterogeneity in population characteristics, timing of assessment, PTSD instruments, forensic settings, and follow-up periods. Results: A total of 32 studies involving 8,746 survivors of sexual assault were included. The reported prevalence of PTSD ranged from 21.4% to 68.9%, with a pooled descriptive estimate of 42.7%. PTSD symptoms were more frequently reported when assessment occurred after the acute post-assault period compared with immediate forensic examination. Important determinants included severity of assault, physical injury, perceived threat to life, repeated assault, childhood sexual abuse, prior psychiatric illness, low social support, self-blame, delayed disclosure, substance-facilitated assault, intimate partner or known perpetrator assault, and ongoing legal stress. Survivors undergoing forensic evaluation frequently reported intrusive memories, avoidance, hyperarousal, sleep disturbance, fear, shame, guilt, and functional impairment. Conclusion: PTSD is highly prevalent among survivors of sexual assault undergoing forensic evaluation. Forensic and medico-legal services should integrate trauma-informed care, early psychological screening, crisis counseling, safety assessment, referral pathways, and follow-up mental health support. Identification of high-risk determinants can help prioritize survivors requiring urgent psychological intervention.
sexual assault, rape, forensic evaluation, post-traumatic stress disorder, PTSD, medico-legal examination, trauma-informed care, survivors, systematic review.
Brainstem Injuries in Fatal Road Traffic Accidents: A Medico-Legal Autopsy Analysis of Pontine and Medullary Lesions from Southern India
Background: Brainstem injuries are among the most devastating consequences of road traffic accidents (RTAs) because they involve vital respiratory, cardiovascular, and neurological centers. Traumatic lesions involving the pons and medulla are frequently associated with instantaneous death or rapid clinical deterioration. Despite their considerable medico-legal significance, these injuries are often overlooked during routine autopsy unless meticulous brainstem examination is performed. Materials and Methods: A cross-sectional autopsy-based study was conducted on 155 fatal road traffic accident victims examined in the Department of Forensic Medicine and Toxicology, Shimoga Institute of Medical Sciences, Karnataka, India, between January and December 2013. During medico-legal autopsy, the brain was removed along with the intact brainstem and upper cervical spinal cord. Serial gross sections of the pons and medulla were examined for traumatic lesions including hemorrhage, contusion, laceration, and transection. Demographic characteristics, road-user category, and brainstem injury patterns were analyzed using descriptive statistics. Results: Among 155 fatal RTA victims, pontine injuries were identified in 17 (10.96%) cases and medullary injuries in 5 (3.2%) cases. Pontine hemorrhage was the commonest lesion (7.1%), followed by transection (3.2%) and laceration (0.6%). Medullary injuries comprised transection (1.9%), contusion (0.6%), and laceration (0.6%). Riders and pedestrians constituted the majority of victims with brainstem injuries. Most victims sustaining medullary or pontine transection died at the scene of the accident. Conclusion: Brainstem injuries represent an important cause of mortality in fatal road traffic accidents. Pontine hemorrhage is the predominant brainstem lesion, whereas medullary transection is strongly associated with instantaneous death. Routine systematic examination of the brainstem during medico-legal autopsy is essential for accurate determination of the mechanism and cause of death.
Brainstem injury; Road traffic accident; Pons; Medulla oblongata; Autopsy; Forensic pathology
Deep Transcranial Magnetic Stimulation With the H4 Coil for Reducing Smoking Addiction in Patients With Comorbid Psychiatric Illness, Including Depression, Psychosis, and Alcohol Use Disorder
Background: Tobacco smoking remains a leading preventable cause of morbidity and mortality worldwide. Deep transcranial magnetic stimulation (DTMS) using the H4 coil targets addiction-related circuits within the bilateral insula and prefrontal cortex and has demonstrated safety and efficacy in reducing smoking craving. However, the influence of comorbid alcohol use disorder, depression, and psychosis on smoking-cessation outcomes remains insufficiently studied. Aim: This study aimed to assess the clinical utility of H4 coil DTMS in reducing nicotine dependence among smokers with alcohol use disorder, depression, or psychosis. Materials and Methods: This retrospective observational study included 33 nicotine-dependent patients treated with DTMS at a tertiary neuromodulation center. Participants had alcohol use disorder, major depressive disorder (MDD), psychosis, or overlapping comorbidities; all were receiving regular psychiatric treatment and underwent DTMS to reduce smoking craving. High-frequency stimulation (10 Hz) was delivered using the BrainsWay H4 coil at 120% of the resting motor threshold. Patients received two sessions daily for five consecutive days, for a total of 10 sessions, with 1800 pulses delivered over 18 minutes per session. All patients also received Motivational Enhancement Therapy and standard-dose varenicline. Nicotine dependence was assessed before and after treatment using the Fagerström Test for Nicotine Dependence (FTND). Results: The mean age of participants was 34 ± 10.34 years. Mean FTND score decreased from 7.27 ± 0.96 at baseline to 3.12 ± 1.37 after treatment, representing a mean reduction of 4.15 points and an average improvement of 56.78 ± 18.96%. Alcohol use disorder was present in 24/33 patients (72%), MDD in 14 (42%), and psychosis in 8 (24%). Hypertension and type-II diabetes mellitus were observed in 10 (30%) and 8 (24%) patients, respectively. By day 5, 24/33 patients (72%) achieved ≥50% improvement. Age and smoking duration showed moderate negative correlations with treatment response. Conclusion: H4 coil DTMS was associated with significant reductions in nicotine dependence in a real-world clinical setting. Outcomes were favourable among smokers with psychiatric comorbidities, supporting DTMS as a useful adjunct to comprehensive smoking-cessation programs. Alcohol use disorder was common, whereas patients with depression showed a lower response than the overall cohort. Controlled studies with long-term follow-up are warranted.
Deep Transcranial Magnetic Stimulation, H4 coil, Smoking cessation, Nicotine dependence, Fagerström Test for Nicotine Dependence.
Histopathological Changes in Sudden Cardiac Death: A Prospective Autopsy-Based Study at Bhopal Region
Background: Cases of sudden cardiac death (SCD) and autopsy-revealed coronary artery lesions in central India have been reported in the literature. Aim: The purpose of this study was to assess cardiac histopathological lesions in sudden cardiac death and their correlation with age and sex. Methods: In this prospective autopsy study (01 March 2025–28 February 2026), a total of hundred sudden, non-traumatic deaths suspected to be cardiac were studied at Gandhi Medical College Bhopal. The heart and coronaries were examined grossly and histopathologically using standard parameters. Results: 73% of cases were males and half of cases aged 40-59 years. Among the participants, a significant 62% showed signs of coronary atherosclerosis, with a notable increase observed as age progressed. 46% had a myocardial infarction acute and/or healed and 35% had left ventricular hypertrophy. Myocarditis and cardiomyopathies together accounted for around 16% of cases, especially in youth. Conclusion: The major cause of SCD in this setting is coronary atherosclerosis which can or cannot have a myocardial infarction. Importantly, this is the case in middle-aged men. Myocarditis and cardiomyopathies are important minorities in younger victims. Carrying out systematic autopsy and histopathology is very important for establishing the cause of SCD. Thereby allowing an opportunity for implementing preventive measures.
sudden cardiac death, autopsy, histopathology, coronary atherosclerosis, myocarditis
Local Infiltration Analgesia Versus Transversus Abdominis Plane (Tap) Block For Postoperative Pain Control In Paediatric Laparoscopic Surgery: A Randomized Controlled Trial
Background and Objective: Paediatric laparoscopic surgery, while minimally invasive, is associated with significant postoperative somatic and visceral pain. Effective pain management is crucial for early mobilization and recovery. This study aims to compare the postoperative analgesic efficacy of local infiltration analgesia at port sites versus ultrasound-guided Transversus Abdominis Plane (TAP) block in children undergoing elective laparoscopic procedures. Methodology: A randomized controlled trial was conducted at the Department of Paediatric Surgery. One hundred twenty children aged 2–12 years, scheduled for elective laparoscopy, were enrolled using consecutive sampling and randomized into two equal groups (n=60). Group A received local surgical site infiltration of 0.25% Bupivacaine (2 mg/kg total), while Group B received an ultrasound-guided bilateral TAP block utilizing 0.25% Bupivacaine (0.5 mL/kg per side). Postoperative pain was assessed using the FLACC scale (for children <4 years) or Visual Analog Scale (VAS) at 2, 6, 12, and 24 hours. The primary outcome was the mean pain score, and the secondary outcome was the time to first rescue analgesia. Results: Both groups exhibited comparable baseline demographics. Group B (TAP Block) demonstrated significantly lower mean pain scores at 6 hours (2.1 ± 0.8 vs 4.3 ± 1.1, p < 0.001) and 12 hours (2.5 ± 0.9 vs 4.8 ± 1.2, p < 0.001) compared to Group A. The mean time to first rescue analgesia was significantly prolonged in Group B (540 ± 85 minutes) compared to Group A (310 ± 60 minutes) (p < 0.001). Conclusion: Ultrasound-guided TAP block provides superior, longer-lasting postoperative analgesia and delays the need for rescue analgesics compared to local port-site infiltration in paediatric laparoscopic surgery.
Paediatric Laparoscopy, Postoperative Pain, Transversus Abdominis Plane Block, Local Infiltration, Bupivacaine, FLACC Scale.
Sleep, Learning, and Academic Achievement in Medical Students: A Systematic Review of Observational Studies
Background: Sleep plays a fundamental role in cognitive functioning, memory consolidation, learning processes, and academic success. Medical students are particularly vulnerable to sleep disturbances due to demanding academic schedules, examination pressure, clinical responsibilities, and lifestyle factors. Although numerous observational studies have investigated the relationship between sleep and academic outcomes among medical students, the available evidence remains dispersed across different educational settings and geographical regions. Objective: To systematically review observational studies evaluating the association between sleep characteristics, learning outcomes, and academic achievement among medical students worldwide. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched from January 2000 to December 2025. Observational studies involving undergraduate or graduate medical students that assessed sleep parameters and reported learning or academic achievement outcomes were included. Data regarding study characteristics, sleep measures, academic outcomes, and associated factors were extracted and narratively synthesized. Results: A total of 38 observational studies involving approximately 27,600 medical students from 24 countries met the inclusion criteria. Poor sleep quality, insufficient sleep duration, and excessive daytime sleepiness were highly prevalent across studies. Thirty-three studies (86.8%) reported a significant association between adverse sleep characteristics and poorer academic outcomes. Students experiencing poor sleep quality or short sleep duration consistently demonstrated lower grade point averages (GPAs), reduced examination performance, impaired concentration, poorer memory retention, and decreased learning efficiency. Academic workload, examination stress, excessive smartphone use, social media engagement, and poor sleep hygiene emerged as major determinants of sleep disturbances. Conclusion: Observational evidence consistently demonstrates that inadequate sleep is associated with impaired learning and poorer academic achievement among medical students. Promoting healthy sleep behaviors may represent an important strategy for improving educational outcomes and student well-being.
Sleep; Learning; Academic achievement; Medical students; Sleep quality; Academic performance; Systematic review; Observational studies.
Sleep Quality and Educational Performance in Undergraduate Medical Students: A Systematic Review and Narrative Synthesis
Background: Background: Sleep quality is a crucial determinant of cognitive functioning, memory consolidation, emotional regulation, and overall well-being. Undergraduate medical students frequently experience poor sleep quality due to demanding academic schedules, examination stress, clinical exposure, and lifestyle-related factors. Growing evidence suggests that inadequate sleep quality may adversely affect educational performance; however, findings across studies remain heterogeneous. Objective: To systematically review and narratively synthesize global evidence regarding sleep quality among undergraduate medical students and its association with educational performance. Methods: A systematic review and narrative synthesis was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched for studies published between January 2000 and December 2025. Observational studies assessing sleep quality among undergraduate medical students and reporting educational performance outcomes were included. Data regarding study characteristics, sleep quality measures, prevalence of poor sleep quality, educational outcomes, and associated factors were extracted and synthesized narratively. Results: A total of 34 studies involving approximately 23,400 undergraduate medical students from 20 countries met the inclusion criteria. Poor sleep quality was reported in 35.8% to 79.4% of participants, with an overall weighted prevalence of 59.8%. Most studies demonstrated a significant association between poor sleep quality and lower grade point averages (GPAs), poor examination scores, impaired concentration, reduced learning efficiency, and increased academic stress. Excessive daytime sleepiness, irregular sleep schedules, and insomnia symptoms were frequently associated with adverse educational outcomes. Academic workload, examination anxiety, smartphone use before bedtime, social media engagement, and poor sleep hygiene emerged as major determinants of poor sleep quality. Conclusion: Poor sleep quality is highly prevalent among undergraduate medical students and is consistently associated with poor educational performance. Interventions aimed at improving sleep hygiene and promoting healthy sleep behaviors may contribute to enhanced academic outcomes and student well-being.
Sleep quality; Educational performance; Undergraduate medical students; Academic achievement; Sleep hygiene; Systematic review; Narrative synthesis.
Sleep Deprivation and Academic Achievement Among Medical Students: A Systematic Review of Global Evidence
Background: Sleep deprivation is increasingly recognized as a major public health concern among university students, particularly those pursuing medical education. Medical students frequently experience inadequate sleep due to demanding academic schedules, clinical responsibilities, examination stress, and lifestyle-related factors. Emerging evidence suggests that chronic sleep deprivation adversely affects cognitive function, learning capacity, memory consolidation, and academic achievement. Objective: To systematically review the global evidence regarding the prevalence of sleep deprivation among medical students and examine its association with academic achievement. Methods: A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines. Electronic databases including PubMed, Scopus, Embase, Web of Science, and Google Scholar were searched for studies published between January 2000 and December 2025. Observational studies evaluating sleep deprivation and academic outcomes among undergraduate or postgraduate medical students were included. Data regarding study characteristics, prevalence of sleep deprivation, sleep duration, academic performance indicators, and associated risk factors were extracted and narratively synthesized. Results: A total of 36 studies comprising approximately 24,800 medical students from 22 countries met the inclusion criteria. The prevalence of sleep deprivation, commonly defined as sleeping less than 7 hours per night, ranged from 41.2% to 88.5%, with an overall weighted prevalence of 65.9%. Most studies reported a significant negative association between sleep deprivation and academic achievement. Students experiencing sleep deprivation demonstrated lower grade point averages (GPAs), poorer examination performance, reduced concentration, impaired memory retention, increased daytime sleepiness, and higher levels of academic stress. Several studies identified academic workload, examination anxiety, excessive screen time, social media use, and caffeine consumption as major contributors to sleep deprivation. Conclusion: Sleep deprivation is highly prevalent among medical students worldwide and is consistently associated with poorer academic achievement. Interventions promoting adequate sleep duration and healthy sleep practices may improve both academic performance and overall well-being among medical students.
Sleep deprivation; Academic achievement; Medical students; Sleep duration; Academic performance; Systematic review.
Sleep Disturbances and Their Association With Academic Performance Among Medical Students: A Systematic Review
Background: Sleep is a fundamental physiological process essential for cognitive functioning, memory consolidation, emotional regulation, and overall health. Medical students are particularly vulnerable to sleep disturbances because of demanding academic schedules, prolonged study hours, clinical responsibilities, examination stress, and lifestyle factors. Increasing evidence suggests that inadequate sleep quality and quantity may adversely affect academic performance; however, the magnitude and consistency of this association remain unclear. Objective: To systematically review and synthesize the available evidence regarding the prevalence of sleep disturbances among medical students and their association with academic performance. Methods: A systematic review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Electronic databases including PubMed, Scopus, Web of Science, Embase, and Google Scholar were searched for studies published between January 2000 and December 2025. Observational studies assessing sleep quality, sleep duration, insomnia, daytime sleepiness, or other sleep-related parameters among undergraduate or postgraduate medical students and reporting academic performance outcomes were included. Data on study characteristics, sleep assessment tools, prevalence of sleep disturbances, and academic outcomes were extracted and narratively synthesized. Results: A total of 32 studies involving approximately 21,500 medical students across multiple countries met the inclusion criteria. The prevalence of poor sleep quality ranged from 32% to 78%, while insufficient sleep duration (<7 hours per night) was reported in 40–85% of participants. Most studies demonstrated a significant association between poor sleep quality and lower academic achievement. Students experiencing sleep disturbances were more likely to report reduced grade point averages, impaired concentration, decreased examination performance, increased absenteeism, and poorer cognitive functioning. Excessive daytime sleepiness and insomnia symptoms were also consistently associated with adverse academic outcomes. Several studies identified stress, electronic device use before bedtime, caffeine consumption, and irregular sleep schedules as major contributing factors. Conclusion: Sleep disturbances are highly prevalent among medical students and are consistently associated with poorer academic performance. Interventions aimed at improving sleep hygiene, stress management, and mental well-being may contribute to enhanced academic outcomes and overall student health. Medical institutions should prioritize sleep health promotion as part of student wellness programs.
Sleep quality; Sleep disturbances; Academic performance; Medical students; Insomnia; Daytime sleepiness; Systematic review
Psychiatric Comorbidity in Patients with Migraine: A Cross-Sectional Hospital-Based Study
Background: Migraine is a prevalent, highly disabling chronic neurological disorder. Clinical and population observations suggest an elevated prevalence of mental health disorders among these patients. This study aims to quantify psychiatric comorbidities in migraineurs using standardised clinical assessment metrics. Methods: A cross-sectional observational study was conducted with 120 migraine patients diagnosed under the International Classification of Headache Disorders (ICHD-3) guidelines. Psychiatric conditions were evaluated using the Hospital Anxiety and Depression Scale (HADS) alongside structured clinical psychiatric diagnostic interviews. Results: Among the 120 recruited participants, 71.7% met the criteria for at least one psychiatric comorbidity. Generalized Anxiety Disorder (GAD) was the most common condition (38.3%), closely followed by Major Depressive Disorder (MDD, 24.2%). Significantly higher rates of psychiatric pathology were observed in patients suffering from migraine with aura compared to those without aura (81.6% vs. 67.1%, p = 0.038). Chronic migraineurs also demonstrated significantly higher anxiety and depression scores compared to episodic sufferers (p < 0.001). Conclusions: Psychiatric comorbidities, specifically anxiety and depressive disorders, are exceptionally prevalent in the migraine population. Integrating routine mental health screenings into standard neurological care is critical to optimizing therapeutic outcomes.
Psychiatric Comorbidity; Generalized Anxiety Disorder; Major Depressive Disorder; Hospital Anxiety and Depression Scale (HADS); Bidirectional Relationship.
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