International Journal of Health and Clinical Research

To evaluate postoperative shoulder tip pain in low pressure versus standard pressure pneumoperitoneum in laparoscopic cholecystectomy

Nair Furqan, Javed Ullah Chauhan, Mohammed Rayaz, Gourav Singh Saini — Thu, 09 Oct 2025 00:00:00 +0000

INTRODUCTION : Laparoscopic cholecystectomy is the gold standard treatment for gallstone disease. Laparoscopic cholecystectomy has rapidly replaced open cholecystectomy for treatment of patients with gall bladder disease especially cholelithiasis .METHODS: The present study was conducted to evaluate the postoperative shoulder tip pain in low pressure versus standard pressure pneumo peritoneum during laparoscopic cholecystectomyRESULTS : The use of low pressure laparoscopic cholecystectomy (LPLC) as compared to standard pressure laparoscopic cholecystectomy (SPLC) significantly decreases the frequency and intensity of postoperative shoulder tip pain. LPLC decreases the demand for postoperative analgesics, decreases postoperative hospital stay and hence improves the quality of life in the early stage of postoperative rehabilitation. CONCLUSION: On the basis of these results, the widespread use of low pressure pneumoperitoneum during laparoscopic cholecystectomy is recommended.

The Endotheliopathy of Sepsis: Vascular Dysfunction as a Therapeutic Target

Kalpana Kuntal, Nishtha Singh, Nidhi Bhatnagar — Thu, 09 Oct 2025 00:00:00 +0000

Background- Sepsis is responsible for nearly one in five deaths worldwide, yet no targeted therapy has improved survival. Increasing evidence identifies the vascular endothelium as the organising principle of sepsis pathophysiology, integrating inflammation, coagulation, and metabolic failure into a single cascade of glycocalyx shedding, junctional disruption, coagulation imbalance, and immunothrombosis. Methods- These lesions underpin haemodynamic incoherence, acute respiratory distress syndrome, acute kidney injury, disseminated intravascular coagulation, and the long-term sequelae of post-sepsis syndrome. Circulating and urinary biomarkers—including syndecan-1, angiopoietin-2, soluble thrombomodulin, and glycosaminoglycans—mirror the extent of endothelial injury and provide translational anchors, yet remain underused in clinical classification and trial design. Result- Most vascular-targeted therapies, such as albumin, antithrombin, recombinant thrombomodulin, vitamin C, and statins, have failed to improve outcomes, largely due to unselected enrolment, delayed intervention, and reliance on crude mortality endpoints. Emerging strategies, including Tie2 agonists, angiopoietin-2 antagonists, and glycocalyx protectants, show promise but require biomarker-guided, adaptive evaluation. Reframing sepsis as endothelial failure offers a unifying paradigm for risk stratification, trial enrichment, and therapeutic innovation. Conclusion- To reduce the global burden, future strategies must be endotype-specific, mechanistically informed, and feasible across both high- and low-resource health systems.

Quality Indicators of Colonoscopy: A Study of 150 Patients

Awanwosa Valentine Agho, Adel Elnashar — Thu, 11 Dec 2025 00:00:00 +0000

Background: Colonoscopy is the most effective method for detecting and preventing colorectal cancer (CRC). Its diagnostic
success is strongly tied to bowel preparation quality and performance metrics such as adenoma detection rate (ADR). Poor
preparation leads to missed lesions, prolonged procedures, and higher repeat-colonoscopy rates, making quality monitoring
essential.
Objectives: This study evaluated colonoscopy performance indicators specifically bowel-prep quality and ADR among
patients undergoing screening, surveillance, and diagnostic colonoscopies. It also assessed how patient comorbidities, lesion
distribution, and histopathology influenced detection outcomes.
Methods: A retrospective quality improvement (QI) review of 150 colonoscopies was performed at Mercy Fitzgerald Hospital
between January and April 2022. Data were extracted from endoscopy and pathology reports, including ASA classification, bowel
preparation quality, lesion characteristics, and recommended follow-up. Descriptive analysis was conducted using SPSS v27.
Results: Most patients were ASA II or III, with a mean age of 61 years. An exceptional ADR of 88% was observed, far surpassing
typical organizational benchmarks (25–30%). Tubular adenomas were the most common finding. Good bowel preparation
yielded the highest lesion-detection efficiency, while excellent prep improved visualization but did not significantly increase
polyp counts. Fair or poor prep was more frequent among patients with higher ASA classifications.
Conclusion: While ADR was exceptionally high, bowel prep quality especially among medically complex patients remains
an area for targeted improvement. Enhanced preparation strategies, individualized regimens, and patient education could
improve visualization, reduce missed lesions, and align performance with national guidelines.

Severe Chest Pain of Non-Cardiac Origin in a Patient with Coronary Artery Disease: A Case Report and Literature Review

Awanwosa Valentine Agho — Tue, 30 Dec 2025 00:00:00 +0000

Chest pain is one of the most common reasons for emergency department presentation and remains a leading cause of hospital
admission worldwide. While acute coronary syndrome is the primary concern, particularly in older adults and patients with
established coronary artery disease, the majority of chest pain cases are ultimately attributable to non-cardiac etiologies.
Distinguishing cardiac from non-cardiac causes is clinically challenging, especially when initial investigations suggest
significant underlying coronary pathology.
We present the case of a 69-year-old male with extensive cardiovascular comorbidities, including prior coronary artery bypass
grafting, who presented with severe, persistent chest pain refractory to standard anti-ischemic therapy. Initial evaluation raised
concern for non–ST-elevation myocardial infarction based on symptoms, risk profile, and imaging findings. Despite appropriate
cardiac management, the patient’s symptoms persisted and his clinical course deteriorated, prompting further investigation.
Subsequent imaging revealed severe acute cholecystitis complicated by hepatic abscess formation, which was identified as
the true source of his chest pain.
This case underscores that non-cardiac conditions, particularly acute biliary pathology, can closely mimic acute coronary syndromes
and may present with chest pain unresponsive to conventional cardiac therapies, even in patients with known coronary artery disease.
Clinicians should maintain a broad differential diagnosis and reassess refractory chest pain systematically to avoid diagnostic
delay, reduce morbidity, and ensure timely, targeted management.

A comprehenshive review on herbal preservatives

Deepak Raghav, Amandeep Singh, Krati, Esha Vatsa, Nidhi Chaudhary — Thu, 29 Jan 2026 00:00:00 +0000

Herbal preservatives are natural substances obtained from plants that help protect pharmaceutical and cosmetic products from microbial contamination, oxidation, and degradation. With increasing concerns about the adverse effects of synthetic preservatives such as parabens and sulphites, herbal preservatives are gaining importance as safer, eco-friendly alternatives. These plant-based preservatives contain bioactive compounds like polyphenols, flavonoids, tannins, essential oils, and organic acids, which exhibit strong antimicrobial, antioxidant, and antifungal properties. Common herbal preservatives include amla (Phyllanthus emblica), green tea (Camellia sinensis), pomegranate (Punica granatum), grapes (Vitis vinifera), rose, clove oil, orange peel extract, and cranberries. These botanicals help extend the shelf life of syrups, cosmetics, oils, and herbal formulations by inhibiting the growth of bacteria, fungi, and Molds. Their antioxidant capacity also prevents the oxidation of oils, pigments, and vitamins, thereby maintaining product stability and quality. For example, amla and green tea are rich in Vitamin C and catechins, pomegranate and grapes contain high levels of tannins and polyphenols, while essential oils like clove and orange provide natural antimicrobial activity. Despite their advantages, challenges include variability in plant composition, extraction stability, and the need for standardization and compatibility studies. Overall, herbal preservatives represent a promising, sustainable, and consumer-friendly approach for enhancing the quality, safety, and shelf life of modern herbal and cosmetic formulations.

Ankylosing Spondylitis: A Comprehensive Review of Clinical Manifestations, Imaging Modalities, Pharmacological Management, and Surgical Interventions

Nitish Kumar Gupta, Esha Vatsa, Nidhi Chaudhary, Krati, Amandeep Singh — Fri, 30 Jan 2026 00:00:00 +0000

Ankylosing spondylitis (AS) is a long-lasting advancing autoimmune inflammatory condition that mainly targets the axial skeleton, sacroiliac joints and enthuses. It frequently results in pain stiffness and structural damage including syndesmophyte formation and spinal ankylosis. AS has a robust genetic foundation particularly linked to the HLA-B27 gene. It also encompasses intricate interactions among immune dysregulation, microbial triggers and environmental influences. Extra-articular manifestations including anterior uveitis gastrointestinal involvement and cardiac abnormalities, add to the disease burden. Diagnosis is based on clinical assessment imaging techniques such as X-ray and MRI along with corroborative lab tests. Strategies for treatment comprise NSAIDs biologic DMARDs (notably TNF-α inhibitors) IL-17 inhibitors and new JAK inhibitors as well as physical therapy and changes in lifestyle.Severe deformities or complications are the only cases in which surgery is performed. This article examines the etiology and clinical features of ASas well as diagnostic methods and evidence based treatment recommendations. It emphasizes that early diagnosis and targeted therapy are essential for improving patient outcomes.