EPH-International Journal of Medical and Health Science
EPH - International Journal of Medical and Health Science (IJMHS) is an open access journal publishing high-quality medical research since 2015. The journal features original research, reviews, and clinical studies with strong scientific and practical relevance. All submissions undergo a double-blind peer review to ensure quality, accuracy, and global accessibility. Publication Standards Rigorous Peer Review All manuscripts undergo a strict double-blind peer review process conducted by qualified experts to ensure originality, scientific accuracy, and research integrity. Open Access Policy The journal provides immediate open access to all published content, supporting unrestricted dissemination of knowledge to researchers worldwide. Ethical Publishing The journal strictly follows international publication ethics, ensuring transparency, plagiarism screening, and adherence to global scholarly standards. Call for Manuscripts Submit your research to a double-blind, open access platform focused on quality and global reach. Submit Now
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FUTURE RESEARCH GAPS IN ECHINACEA PURPUREA THERAPEUTICS
Herbal medicine research faces various hurdles that hinder its inclusion into current healthcare system. A major concern is the non-uniformity and non-uniformity of the phytochemical constituents, affecting therapeutic uniformity and reproducibility. Further limiting scientific confirmation is a not sufficient understanding of mechanisms of action. Moreover, comprehensive studies of complex and complicated herbal compositions are constrained by the limited application of state-of-the-art omics technologies. Clinical trials are often limited to therapeutic indications and poorly designed, whereas preclinical studies often have discrepancies. Poor pharmacokinetic and bioavailability data compound the process of dosage optimization. The toxicological profile, the interactions between drugs and herbs, and long-term safety issues have not yet been sufficiently investigated. Adulteration, quality control, formulation and administration of the drug are other factors contributing to market variability. Regulatory hurdles add to the delay in clinical translation, as do real-world data limitations. To overcome these limitations and promote the development and wide-spread use of herbal remedies, standardized procedures, cutting-edge technologies, and comprehensive clinical evaluation are required.
VITAMIN D DEFICIENCY AND PSYCHOLOGICAL WELL-BEING IN KERALA: A SYSTEMATIC REVIEW OF MENTAL HEALTH OUTCOMES, EMOTIONAL RESILIENCE, COGNITIVE REAPPRAISAL, NEUROTICISM, AND LOCUS OF CONTROL
Vitamin D deficiency has emerged as a major public health concern across the world, affecting individuals across age, gender, region, and socioeconomic status. Although vitamin D has traditionally been understood in relation to calcium absorption, bone mineralization, and skeletal health, recent research has increasingly emphasized its role in brain functioning, emotional regulation, cognitive processes, immune modulation, and psychological well-being. The presence of vitamin D receptors in several brain regions involved in mood regulation, stress response, memory, and executive functioning has encouraged growing scholarly interest in the psychological implications of vitamin D deficiency. India presents a unique public health paradox because vitamin D deficiency remains highly prevalent despite abundant sunlight exposure. Kerala, a tropical state with year-round sunlight and relatively strong health indicators, offers a particularly important context for examining this paradox. Changing lifestyles, indoor occupations, urbanization, academic pressures, reduced outdoor activity, dietary transitions, and sun-avoidance behaviors may contribute to persistent vitamin D deficiency among Kerala populations. This systematic review aims to synthesize existing literature on the association between vitamin D deficiency and psychological well-being, with specific attention to depression, anxiety, emotional resilience, cognitive reappraisal, neuroticism, and locus of control. The review adopts a systematic literature-based approach guided by PRISMA principles and draws upon studies published between 2000 and 2024. Existing evidence suggests that low vitamin D status is associated with increased depressive symptoms, anxiety, psychological distress, cognitive vulnerability, reduced emotional resilience, maladaptive emotion regulation, and poorer quality of life. However, Kerala-specific psychological research remains limited. The review highlights the need for interdisciplinary research integrating nutrition, psychology, psychiatry, and public health. Addressing vitamin D deficiency may offer a low-cost, preventive strategy for improving psychological well-being and mental health outcomes.
ASSESSMENT OF AWARE-BASED ANTIBIOTIC CONSUMPTION AMONG ADULT ICU PATIENTS AT A TERTIARY CARE HOSPITAL: A PROSPECTIVE OBSERVATIONAL STUDY
Background Antimicrobial resistance (AMR) is a growing global health concern, particularly in intensive care units (ICUs), where broad-spectrum antibiotic use is common. The World Health Organization (WHO) introduced the AWaRe (Access, Watch, Reserve) classification to optimize antimicrobial stewardship and monitor antibiotic consumption patterns. Aim To estimate antibiotic consumption among adult ICU patients admitted to a tertiary care teaching hospital during January–December 2024 using the WHO AWaRe classification and Defined Daily Dose (DDD)/100 bed-days methodology. Materials and Methods A prospective observational study was conducted in adult ICUs of Government General Hospital (GGH), Guntur, from January to December 2024. Antibiotic consumption data were obtained from the central pharmacy and categorized according to the WHO AWaRe classification. Consumption was quantified using the Anatomical Therapeutic Chemical (ATC)/DDD methodology and expressed as DDD/100 bed-days. Monthly and annual trends in antimicrobial utilization were analyzed. Results The total antimicrobial consumption was 732.3 DDD/100 bed-days. Watch group antibiotics accounted for 563.8 DDD (77.0%), followed by Access antibiotics with 153.1 DDD (20.9%) and Reserve antibiotics with 15.4 DDD (2.1%). Ceftriaxone was the most consumed antibiotic (299.9 DDD/100 bed-days), followed by Amikacin (87.6 DDD/100 bed-days) and Piperacillin-Tazobactam (75.1 DDD/100 bed-days). Monthly antimicrobial consumption varied from 42.8 DDD/100 bed-days in October to 72.4 DDD/100 bed-days in July. Access antibiotic utilization remained substantially below the WHO target of ≥60%. Conclusion Watch category antibiotics dominated prescribing practices in adult ICUs, while Access antibiotic use remained considerably below WHO recommendations. Continuous antimicrobial stewardship interventions are necessary to optimize antibiotic utilization and reduce the risk of antimicrobial resistance.
ROLE OF BODY MASSAGE IN NEONATAL CARE: BENEFITS, MECHANISMS, AND CLINICAL EVIDENCE
Body massage is an ancient practice valued across many cultures for its positive effects on infant health and development. In recent years, it has been increasingly recognized in pediatric care for helping babies physically, emotionally, and in forming a close bond with their caregivers. This article explores the benefits of body massage, especially in addressing common issues like colic, irregular sleep, and digestive troubles. These challenges, often due to underdeveloped systems in infants, can cause discomfort and affect growth. Massage has been shown to ease these issues by improving sleep, boosting immunity, supporting muscle development, and reducing stress. This article also explains safe massage techniques, including choosing a calm setting, using natural oils, and applying gentle, rhythmic strokes. As a simple, non-invasive approach, body massage not only improves infant comfort but also strengthens the parent-child bond, making it a valuable addition to neonatal care.
ASSOCIATION OF DRY EYE DISEASE WITH DIABETIC RETINOPATHY SEVERITY IN TYPE 2 DIABETES MELLITUS: AN OBSERVATIONAL STUDY
Purpose To evaluate the association between dry eye disease (DED) and severity of diabetic retinopathy (DR) in patients with type 2 diabetes mellitus (T2DM), and to assess the relationship between duration of diabetes and dry eye severity. Methods This cross-sectional observational study included 150 patients with type 2 diabetes mellitus attending the ophthalmology outpatient department of a tertiary care centre . All patients underwent detailed ophthalmic evaluation including Ocular Surface Disease Index (OSDI) questionnaire, Schirmer I test, Tear Film Break-Up Time (TBUT), fluorescein corneal staining, and fundus examination. Diabetic retinopathy was graded according to Early Treatment Diabetic Retinopathy Study (ETDRS) classification. Correlation between dry eye parameters and diabetic retinopathy severity was analyzed statistically. Results A significant association was observed between severity of diabetic retinopathy and severity of dry eye disease on Schirmer I test, TBUT, OSDI score, and corneal fluorescein staining (p<0.05). Severe dry eye was more frequently observed in patients with severe non-proliferative diabetic retinopathy (NPDR) and proliferative diabetic retinopathy (PDR). Duration of diabetes also showed significant correlation with worsening dry eye parameters (p<0.001). Patients with diabetes duration greater than 10 years demonstrated more severe tear film dysfunction and ocular surface abnormalities. Conclusion Dry eye disease severity increases with worsening diabetic retinopathy and longer duration of diabetes mellitus. Ocular surface evaluation should be considered an important component of routine diabetic eye assessment, particularly in patients with advanced diabetic retinopathy.
CLINICORADIOLOGICAL, ETIOLOGICAL PROFILE AND OUTCOME IN MODERATE TO MASSIVE HEMOPTYSIS IN ADMITTED PATIENTS IN A TERTIARY CARE HOSPITAL
Hemoptysis is the expectoration of blood from the respiratory tract and ranges from mild blood-streaked sputum to massive life-threatening bleeding. Moderate to massive hemoptysis is associated with significant morbidity and mortality, requiring prompt evaluation and management. In developing countries like India, pulmonary tuberculosis remains one of the most common causes, while bronchiectasis, bronchitis, and lung malignancy are also important etiologies. This prospective observational study aims to determine the clinicoradiological profile, etiology, and outcome of moderate to massive hemoptysis in patients admitted to a tertiary care hospital in Telangana. The study will include 100 patients presenting with true active hemoptysis who meet the inclusion criteria and are willing to participate. Patients with hematemesis, oral bleed, epistaxis, and upper respiratory tract infections will be excluded. Data collection will include detailed clinical history, physical examination, chest X-ray, computed tomography, sputum examination including CBNAAT and culture studies, and fibre optic bronchoscopy. The study will be conducted over a period of 18 months at Government General and Chest Hospital, Erragadda. The study is expected to provide valuable insights into the clinical presentation, radiological findings, underlying etiologies, and outcomes of moderate to massive hemoptysis, thereby contributing to improved diagnosis and management strategies.
Copyright (c) 2026 EPH-International Journal of Medical and Health Science https://creativecommons.org/licenses/by-nc/4.0
A COMPARATIVE STUDY ON PREDISPOSING FACTORS FOR THE DEVELOPMENT OF DRUG SUSCEPTIBLE AND DRUG RESISTANT CASES IN PULMONARY TB RETREATMENT CASES AT GOVERNMENT CHEST DISEASES AND TB HOSPITAL, HANUMAKONDA
Background: Drug-resistant tuberculosis (DR-TB) remains a major challenge to tuberculosis control programmes, particularly among retreatment pulmonary TB cases. Identifying factors associated with the development of drug resistance is essential for improving treatment outcomes and preventing transmission. Materials and Methods: This analytical observational cross-sectional study was conducted over 24 months (May 2023–April 2025) at Government Chest Diseases and Tuberculosis Hospital, Hanumakonda. A total of 100 pulmonary TB retreatment cases aged ≥18 years were included, comprising 50 drug-resistant (DR-TB) and 50 drug-sensitive (DS-TB) cases. Demographic, clinical, microbiological, radiological, and treatment-related factors were assessed. Data were analyzed using SPSS software, and associations were evaluated using the Chi-square test, with p<0.05 considered statistically significant. Results: Significant factors associated with DR-TB included older age (p=0.037), male gender (88% vs. 68%, p=0.0158), illiteracy (26% vs. 10%, p=0.0373), alcohol consumption (84% vs. 62%, p=0.013), smoking (p=0.0001), multiple previous TB episodes (26% vs. 10%, p=0.037), longer interval between TB episodes (p=0.0004), previous loss to follow-up (64% vs. 42%, p=0.027), and default during the intensive phase of prior treatment (p=0.007). Undernutrition and anaemia were highly prevalent and significantly associated with disease status. HIV, diabetes mellitus, hypoproteinemia, sputum smear positivity, and radiological severity did not show significant association with drug resistance. Conclusion: Male gender, poor education, smoking, alcohol use, multiple TB episodes, and treatment default were important predictors of DR-TB. Strengthening counselling, adherence monitoring, nutritional rehabilitation, and tobacco/alcohol cessation interventions may help reduce the burden of drug-resistant tuberculosis.
ROLE OF PLEURAL FLUID ADENOSINE DEAMINASE AND LYMPHOCYTE NEUTROPHIL RATIO IN DIFFERENTIATING TUBERCULOUS PLEURAL EFFUSION FROM OTHER EXUDATIVE EFFUSIONS
Tubercular Pleural Effusion is the second most common extrapulmonary tuberculosis with incidence of 3-5% in low burden areas and upto 30% in high burden areas. In general, a cutoff level of between 40 and 45 U/L is used with levels above this being indicative of tuberculosis. An ADA level above 70 U/L in a patient who does not have an empyema or rheumatoid arthritis (RA) is essentially diagnostic of tuberculous pleuritis. (1,2,5,6) High pleural fluid ADA levels have also been reported with a very small percent of other neoplasms, with Q fever, with Brucellosis and with Legionnaire's disease Lymphocyte/Neutrophil (L/N) ratio >0.75 is seen to be more likely of TB pleural effusion. (1,2) Aim and Objectives: To evaluate the role of Adenosine deaminase (ADA) and Lymphocyte Neutrophil Ratio (L/N RATIO) in differentiating Tuberculous pleural effusion from other exudative pleural effusion. To study the demographical, clinical, radiological, and microbiological profile in various exudative pleural effusions. To assess Sensitivity, Specificity, PPV, NPV of pleural fluid ADA and L/N Ratio in tubercular and other exudative effusions. Patients and Methods: An Institutional based Prospective Observational study was conducted among the patients attended the tertiary care centre in Warangal from May 2023 to April 2025. In current study, ADA levels are seen to be elevated (> 40IUL) in all the patients with empyema (100%) followed by patients with tubercular pleural effusion (81.2%). This study demonstrates L/N ratio more than 0.75 in all patients with tubercular pleural effusion (100%) followed by patients with malignancy (95%) and parapneumonic effusion empyema (80%). Whereas, majority (71.4%) patients with empyema had L/N ratio less than 0.75.In present study a pleural fluid ADA has high sensitivity (93.1%), high Specificity (96%), high PPV (84%) and high NPV (66%). Pleural fluid L/N ratio also has high sensitivity (99%), high Specificity (100%), high PPV (89%) and high NPV (91%). Hence combined use of both these biochemical marker increases diagnostic accuracy.
TRANSNASAL HIGH-FLOW OXYGEN THERAPY VERSUS NON-INVASIVE POSITIVE PRESSURE VENTILATION IN ACUTE EXACERBATION OF CHRONIC OBSTRUCTIVE PULMONARY DISEASE PATIENTS WITH TYPE II RESPIRATORY FAILURE
Background: Non-invasive ventilation (NIV) is the standard of care for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) with type II respiratory failure. However, patient discomfort and interface intolerance often limit its use. Transnasal high-flow oxygen therapy (TNHFOT) has emerged as a potential alternative that may improve tolerance while maintaining gas exchange. Aim & Objectives: This prospective comparative study aimed to compare the safety and efficacy of TNHFOT versus NIV in AECOPD patients with type II respiratory failure. Objectives included assessing effectiveness, clinical outcomes, and duration of ICU stay.Methods: 70 patients with AECOPD and type II respiratory failure (PaCO₂ >45 mmHg, RR >25) were enrolled at Osmania Medical College, Hyderabad, and divided equally into TNHFOT (n=35) and NIV (n=35) groups. TNHFOT was delivered at 30-60 L/min with FiO₂ 100%. NIV was delivered via BiPAP with IPAP 15 cm H₂O, EPAP 6 cm H₂O, and PEEP 6. Respiratory variables including ABG, SpO₂, and RR were measured 12th hourly.Results: Most patients were aged 65-70 years with male predominance. Treatment failure rates were 25.7% in the HFNC group vs 14.3% in the NIV group. Invasive ventilation was required in 14.3% of HFNC patients vs 5.7% of NIV patients (P = 0.026). Length of ICU stay was 7 days for HFNC vs 9 days for NIV (P = 0.059). 28-day mortality was 8.6% for HFNC vs 5.7% for NIV (P = 0.485).Conclusion: Both TNHFOT and NIV are viable options for managing AECOPD with type II respiratory failure. NIV showed lower treatment failure and invasive ventilation rates. However, TNHFOT was associated with better patient tolerance and a trend toward shorter ICU stay. TNHFOT may serve as a comfortable and effective alternative to NIV in select patients.
STUDY ON SERUM ELECTROLYTES AMONG PATIENTS WITH CHRONIC OBSTRUCTIVE PULMONARY DISEASE
Introduction: Chronic obstructive pulmonary disease (COPD) is one of the most important diseases among adults which is associated with significant morbidity, mortality and quality of life. Presence of electrolyte imbalance affects the outcome of the patients with COPD particularly in those with acute exacerbation of COPD (AECOPD). Objectives: To find out the prevalence of electrolyte imbalance in patients with COPD To identify the relation between severity of COPD and electrolyte levels. Methodology: A cross sectional study was conducted for a period of 6 months from January to June 2025. Both male and female patients those who were aged more than 18 years admitted in the in-patient department of General Medical department were included in the study. Patients in all stages of COPD were recruited. All patients were interviewed using a structured proforma and the investigations such as complete blood count (CBC), liver function test (LFT), renal function test (RFT), serum sodium, potassium, calcium, phosphorus, chest X ray and spirometry were done. Appropriate statistical tests were performed. Results: A total of 100 patients with COPD were included in the study. Mean age of the study participants was 57.8 years. Majority of the participants (78%) were male. Complete blood count, liver function test and renal function test were normal in all the patients. All the patients had hyperinflation of lungs in the X ray. The mean FEV1 (predicted %) in the study group was 57.9% which was ranging from 36 to 75%. Among the total study participants, 74% had moderate COPD and 26% had severe COPD. The mean sodium and potassium level was significantly less among patients with severe COPD than patients with moderate COPD. Serum calcium and phosphorous levels were almost similar between patients with moderate and severe COPD. Among the total 100 patients, 27% had hyponatremia, 12% had hypokalemia, 1% had hypophosphatemia and all the patients had normal calcium levels. Conclusion: Hyponatremia and hypokalemia were common in patients with COPD. Severity of COPD had significant association with electrolyte levels.
Copyright (c) 2026 EPH-International Journal of Medical and Health Science
ANTIBACTERIAL EFFECT OF PROPOLIS MODIFIED AND NON PROPOLIS MODIFIED COLLAGEN MEMBRANE AGAINST P.GINGIVALIS AND S. MUTANS – AN IN VITRO STUDY
Background: Collagen Membranes used in Guided tissue regeneration, are prone to microbial colonization, which can reduce their therapeutic efficiency. Propolis, a naturally occurring antibacterial agent, may be added to enhance the clinical results and strengthen antimicrobial qualities. Aim: To evaluate and compare the antibacterial efficacy of propolis modified and non propolis modified collagen membrane against Streptococcus mutans and Porphyromonas gingivalis Materials & Methods: An in vitro comparative study was conducted using sterile collagen membrane discs. An ethanolic extract of propolis (EEP) was added to test membranes. The agar diffusion assay (zone of inhibition) and colony forming unit (CFU) measurement were used to evaluate the antibacterial efficacy. Propolis extract alone serves as the reference control Results: Propolis extract alone demonstrated the highest antibacterial activity. Unmodified collagen membranes exhibited negligible inhibition. Propolis-modified membranes showed measurable antibacterial effects against both microorganisms. Zones of inhibition were more pronounced against P. gingivalis. CFU analysis revealed substantial bacterial reduction with propolis treatment, with the modified membranes demonstrating intermediate efficacy compared to propolis extract alone. These differences were statistically significant (P <0.05) Conclusion: propolis incorporation strengthen the antibacterial capability of collagen membranes, and may increase their performance during periodontal regeneration
ASSESSMENT OF BACTERIAL ADHERENCE AND BIOFILM FORMATION OF STREPTOCOCCUS MUTANS ANDPORPHYROMONAS GINGIVALIS ON XENOGRAFT AND PERIOGLAS BONE GRAFT MATERIALS – AN IN VITRO STUDY
Background Bacterial colonization and biofilm formation on bone graft materials can compromise periodontal regenerative outcomes. Xenografts and bioactive glass (PerioGlas®) are widely used graft materials; however, limited data exist regarding their susceptibility to microbial adherence. Aim To evaluate and compare the bacterial adherence and biofilm formation of Streptococcus mutans and Porphyromonas gingivalis on xenograft and PerioGlas® bone graft materials under in vitro conditions. Materials And Methods An in vitro study was conducted using xenograft and PerioGlas® samples inoculated with S. mutans and P. gingivalis. After incubation, biofilm formation was assessed using crystal violet staining. The intensity of staining was evaluated to quantify bacterial adherence and biofilm formation. All experiments were performed in triplicate. Results PerioGlas® demonstrated significantly reduced biofilm formation compared to xenograft. The percentage of biofilm inhibition by PerioGlas® was 19.64% for S. mutans and 36.1% for P. gingivalis, indicating superior resistance to bacterial colonization. P-values <0.05 were considered statistically significant. Conclusion PerioGlas® exhibited significantly lower bacterial adherence and biofilm formation than xenograft. These findings suggest that PerioGlas® may offer improved resistance to microbial colonization, potentially enhancing the success and predictability of periodontal regenerative procedures.
A PROSPECTIVE OBSERVATIONAL STUDY IN PREDICTING DIABETIC FOOT ULCERS BY USING SINBAD SCORING SYSTEM
Background: Diabetic foot ulcers remain one of the most serious complications of diabetes mellitus and are a major contributor to lower-limb amputations globally. Reliable and easily applicable classification systems are essential for early risk stratification and outcome prediction. The SINBAD Classification System is a practical scoring tool that evaluates ulcer site, ischemia, neuropathy, bacterial infection, ulcer area, and ulcer depth to determine ulcer severity. Aim and Objectives: To analyze the clinical characteristics and outcomes of patients with diabetic foot ulcers and to determine the prognostic utility of the SINBAD Classification System in predicting ulcer healing and limb salvage. Methods: A prospective observational study was conducted involving 150 patients with diabetic foot ulcers presenting to a tertiary care center. Clinical data including demographic variables, duration of diabetes, comorbidities, ulcer characteristics, and microbiological findings were recorded. Ulcer severity was assessed using the SINBAD Classification System. Patients were followed until resolution of the ulcer or occurrence of adverse outcomes, including disarticulation, major amputation, or persistent non-healing. Statistical analyses were performed to evaluate associations between clinical variables, SINBAD scores, and treatment outcomes. Results: The majority of patients were aged 61–70 years (44.6%) with a predominance of males (70.0%). Forefoot ulcers were most common (71.3%). Neuropathy and ischemia were present in 41.3% and 61.3% of patients, respectively. Overall, complete ulcer healing was achieved in 52.7% of cases, while 19.3% required disarticulation and 17.3% underwent major amputation. Increasing SINBAD Classification System scores demonstrated a significant association with adverse outcomes (p=0.04). Advanced age, longer duration of diabetes, presence of neuropathy, and ulcer location were also significantly associated with poorer clinical outcomes. Conclusion: The SINBAD Classification System is a simple and clinically effective tool for prognostic assessment in diabetic foot ulcers. Higher SINBAD scores correlate with increased risk of amputation and reduced healing rates. Early implementation of this scoring system may facilitate timely intervention, optimize management strategies, and improve limb-salvage outcomes in patients with diabetic foot disease
INTEGRATED SYSTEMS BIOLOGY AND MACHINE LEARNING FRAMEWORK FOR THE IDENTIFICATION OF MITOCHONDRIAL AND SIGNALING SIGNATURES IN ISCHEMIC AND DILATED CARDIOMYOPATHY
Cardiovascular diseases (CVDs), predominantly manifested as ischemic cardiomyopathy (ICM) and dilated cardiomyopathy (DCM), constitute the leading cause of morbidity and mortality worldwide, driven by a complex architecture of genetic, metabolic, and environmental alterations. Traditional clinical diagnostic modalities, while effective for hemodynamic assessment, often fail to capture the granular molecular heterogeneity required for early intervention and personalized therapeutic strategies. The advent of high- throughput transcriptomics has provided a systems-level view of these pathologies, yet the translation of high- dimensional genomic data into robust clinical biomarkers remains hindered by the "curse of dimensionality" and the noise inherent in biological datasets. This study presents a comprehensive, integrated bioinformatics and machine learning pipeline to identify a compact, biologically potent gene signature for CVD classification. Drawing conceptual inspiration from the "Moana" classification framework—which prioritizes biological structure over raw feature variance—we employed a pathway-guided feature selection strategy on RNA- sequencing data (GSE55296) and microarray validation datasets (GSE57338). Functional enrichment analysis using KEGG and Reactome databases revealed a profound dysregulation of mitochondrial metabolism, oxidative phosphorylation, and cardiomyopathy-related pathways. Subsequent protein–protein interaction (PPI) network analysis, refined through the intersection of multiple topological centrality algorithms (Degree, Maximal Clique Centrality, and Betweenness), distilled the transcriptome into a core signature of six genes: COX4I1, NDUFA5, NDUFV2, NDUFS3, NDUFS4, and AKT1. These features were utilized to train and evaluate supervised machine learning models. The Random Forest classifier demonstrated superior stability and performance, achieving a mean cross-validation accuracy of approximately 69.5%, significantly outperforming a Deep Neural Network (DNN) in this limited-sample regime. The findings underscore the critical role of mitochondrial Complex I and IV dysfunction in heart failure and demonstrate the efficacy of integrating systems biology with ensemble learning to develop interpretable, high-precision molecular diagnostics.
A DATA-DRIVEN PARADIGM FOR FORECASTING TYPE 2 DIABETES RISK THROUGH THE INTEGRATION OF MACHINE LEARNING TECHNIQUES AND CLINICAL DATA WITHIN A UNIFIED WEB-BASED PLATFORM
Type 2 diabetes mellitus (T2DM) has emerged as one of the most significant metabolic disorders affecting populations globally, necessitating the development of sophisticated early screening methodologies. The integration of artificial intelligence and data science in clinical applications has created unprecedented opportunities for improving disease prediction accuracy while advancing the United Nations Sustainable Development Goal 3 (Good Health and Well-Being). This research endeavors to establish a robust predictive framework by systematically evaluating multiple classification algorithms across four distinct diabetes- related datasets obtained from Kaggle and the UCI Machine Learning Repository. Our comprehensive analysis encompasses eight traditional machine learning classifiers alongside three deep neural network architectures, with model effectiveness measured using standard evaluation metrics including Accuracy, Precision, Recall, F1-Score, and Area Under the ROC Curve (AUC). We introduce a dimensionality reduction strategy based on Principal Component Analysis (PCA) to optimize feature representation, comparing i ts effectiveness against LASSO-based feature selection. Our experimental findings demonstrate that the XGBoost classifier combined with PCA-based feature engineering delivers exceptional predictive capability, achieving approximately 97% accuracy and F1 -score with a 96% AUC across the diabetes datasets. The optimized model has been deployed within an intuitive web-based application designed to facilitate accessible diabetes risk assessment. Additionally, we propose an integrated digital health framework incorporating Internet of Medical Things (IoMT), Robotic Process Automation (RPA), and AI technologies to enhance the reliability and scalability of personalized diabetes management solutions.
URINARY TRACT INFECTIONS IN TYPE 2 DIABETES: AN ANALYSIS OF PREVALENCE AND CONTRIBUTING FACTORS
Background: Type 2 Diabetes Mellitus (T2DM) is a chronic metabolic disorder with rising global prevalence, frequently associated with complications such as urinary tract infections (UTIs). Diabetic patients are more susceptible to UTIs due to impaired immune responses, glycosuria, and bladder dysfunction, resulting in more frequent, severe, and recurrent infections. Objective: This study aimed to assess the prevalence, risk factors, and microbial etiology of UTIs among patients with T2DM presenting with clinical features suggestive of infection. Methods: A prospective observational study was conducted at the Teerthanker Mahaveer University College of Paramedical Sciences and the Department of Microbiology, Teerthanker Mahaveer Hospital & Research Centre, Moradabad. A total of 158 T2DM patients aged above 18 years with symptomatic features of UTI were enrolled. Midstream urine samples were collected aseptically and analyzed using standard microbiological techniques including culture on CLED agar, wet mount microscopy, and Gram staining. Significant bacteriuria was defined as colony growth ≥10⁵ CFU/ml based on Kass criteria. Results: Of the 158 urine samples, 40 (25.31%) showed significant bacteriuria. The prevalence was highest among patients aged >35 years. Gram-negative bacteria accounted for 65% of isolates, with Escherichia coli being the most common pathogen (52.5%), followed by Staphylococcus aureus (12.5%) and Pseudomonas aeruginosa (10%). Gram-positive organisms comprised 35% of isolates. Conclusion: The study reveals a notable prevalence of UTIs among T2DM patients, particularly in older adults. E. coli remains the predominant uropathogen. Early microbiological evaluation and culture-guided antimicrobial therapy are crucial for managing UTIs in diabetics. Routine screening and timely diagnosis can significantly reduce complications and improve clinical outcomes in this high-risk population.
RECURRENT MIDFACIAL PLEXIFORM NEUROFIBROMA ASSOCIATED WITH NEUROFIBROMATOSIS TYPE 1: A CASE REPORT
Plexiform neurofibroma (PNF) is a rare benign peripheral nerve sheath tumor and a pathognomonic manifestation of Neurofibromatosis Type 1 (NF1). These tumors are characterized by diffuse infiltrative growth involving multiple nerve fascicles and are associated with significant cosmetic deformity, functional impairment, recurrence, and risk of malignant transformation. Craniofacial involvement poses considerable diagnostic and surgical challenges because of extensive soft tissue infiltration and proximity to vital anatomical structures. A review of head and neck neurofibromas reported that approximately 25% of all neurofibromas are seen in the head and neck region and 6.5% occur in the oral cavity as solitary or multiple lesions associated with NF-1. 1 This report presents a 29-year-old male with a 17-year history of progressively enlarging recurrent midfacial swelling associated with NF1. The patient had previously undergone two surgical debulking procedures, both followed by rapid recurrence. Clinical examination revealed a large lobulated left midfacial mass with classical “bag of worms” consistency, axillary freckling and an intraoral palatal swelling. MRI and ultrasonography demonstrated diffuse infiltrative soft tissue involvement with associated vascular-lymphatic malformation. Histopathological examination showed thickened nerve bundles composed of Schwann cells with wavy hyperchromatic nuclei embedded within a myxoid stroma, confirming the diagnosis of plexiform neurofibroma. This case highlights the aggressive recurrent nature of craniofacial PNF and emphasizes the importance of clinicoradiological and histopathological correlation for accurate diagnosis and long-term management.
Copyright (c) 2026 EPH-International Journal of Medical and Health Science https://creativecommons.org/licenses/by-nc-nd/4.0
STUDY OF EFFICACY OF ADDITION OF KINESIOLOGICAL TAPING WITH CONVENTIONAL PHYSIOTHERAPY IN CASE OF TRAUMATIC BRACHIAL PLEXUS INJURY A CASE REPORT
Rationable- Adult traumatic brachial plexus injury is a serious and difficult to treat peripheral nerve injuries, it leads to multiple physical disabilities ,sensory and motor deficit .It is devastating, and occurring with increasing frequency. Physical therapist does Patient evaluation concentrating over upper limb sensory and motor function with radiologic studies. This study discusses conservative management and addition of kinesiological taping to comprehensive Rehabilitation Protocol for Brachial Plexus Injury. Kinesiological taping helps in pain management, improved circulation selective immobilization of the soft tissues and at the same time correction of biomechanics of the joints and the muscles involved. It provide proprioceptive sensory stimulation through the soft tissue. To ensure the efficiency of the protocol, therapist documented progress using MMT modified oxford grading, and validated functional outcome scales (e.g., DASH score) with nerve conduction test pre and post rehabilitation. Patient concern- Intense neuropathic pain, especially of the neck and shoulder Sever Sensory and motor deficit. Tenderness over affected tissues. Weakness or heaviness in the extremity, loss of function ,psychological distress. Diminished pulses . Intervention- One adult patient with traumatic BPI underwent with kinesiotaping , with muscle stimulation and specialized exercise prescription .kinesiotaping once in a week and muscle stimulation alternate days. Record the patient’s MMT MRC grading with VAS and DASH score pre rehab and 2 weeks,1 month,2months,and 6,month after rehab. Diagnosis- Adult with traumatic brachial plexus injury preganglionic . Outcome-After kinesiotaping Marked improvement in VAS scale, MMT , and improved DASH score. However exercise protocol was being followed by the patient with taping. Abbreviation-MMT,NCV, BPI, DASH score.
IMPACT OF LIFESTYLE AND TREATMENT INTERVENTIONS ON MENTAL HEALTH OUTCOMES: A CROSS-SECTIONAL STUDY
This study aimed to examine the impact of lifestyle behaviours and treatment interventions on mental health outcomes using a cross-sectional design. A total of 2500 participants from diverse demographic and socioeconomic backgrounds were included in the analysis. Data were collected on mental health status, lifestyle factors such as physical activity and sleep, and treatment interventions including therapy and medication. Descriptive and inferential statistical analyses were performed to assess associations between variables. The findings revealed that 35.08% of participants reported good mental health outcomes, while 30.84% reported fair outcomes, indicating a moderate overall mental health status within the population. Participants engaging in moderate to high physical activity and maintaining adequate sleep duration demonstrated better mental health outcomes compared to those with low activity levels and poor lifestyle patterns. Additionally, individuals receiving combined treatment interventions, including both therapy and medication, showed more favourable outcomes than those receiving a single form of treatment. The results suggest a significant association between healthy lifestyle behaviours, treatment engagement, and improved mental health. The study highlights the importance of integrating lifestyle modifications with clinical interventions to achieve optimal mental health outcomes. Despite limitations related to the cross-sectional design and self-reported data, the findings provide valuable insights for developing holistic and evidence-based approaches to mental health care.
Copyright (c) 2025 EPH-International Journal of Medical and Health Science
CLINICAL AND EPIDEMIOLOGICAL DETERMINANTS OF STROKE IN ADULTS
Stroke remains a major cause of mortality and long-term disability worldwide, posing a substantial burden on individuals, healthcare systems, and public health. This study aimed to examine the clinical and epidemiological determinants associated with stroke occurrence in adults. A quantitative cross-sectional analytical design was adopted using a structured secondary dataset comprising 5,110 adult records. The analysis included demographic, clinical, and lifestyle-related variables, namely age, gender, hypertension, heart disease, marital status, work type, residence type, average glucose level, body mass index, smoking status, and stroke status. Descriptive statistics were used to summarize the study variables, while inferential statistical techniques, including Chi-square tests and independent sample t-tests, were applied to assess the association between predictor variables and stroke occurrence. The findings revealed that age, hypertension, heart disease, average glucose level, body mass index, marital status, work type, and smoking status were significantly associated with stroke. Individuals with stroke had higher mean age, glucose level, and body mass index than those without stroke. Hypertension and heart disease emerged as the strongest clinical determinants, with substantially higher stroke prevalence among affected participants. In contrast, gender and residence type were not significantly associated with stroke occurrence. Overall, the findings indicate that stroke in adults is influenced by a combination of clinical, epidemiological, and lifestyle-related factors. These results highlight the need for integrated prevention strategies emphasizing cardiovascular risk screening, metabolic monitoring, and targeted public health interventions to reduce stroke burden and improve adult health outcomes.
ASSESSING THE IMPACT OF SOCIO-DEMOGRAPHIC AND LIFESTYLE FACTORS ON COMMUNITY HEALTH OUTCOMES: AN EVIDENCE-BASED ANALYSIS FOR PUBLIC HEALTH AND SOCIAL CARE INTERVENTIONS
Understanding the determinants of community health outcomes is essential in the context of rising chronic disease burden and increasing pressure on healthcare systems. While socio-demographic and lifestyle factors are widely recognized as key influences on health, their direct relationship with healthcare utilization remains insufficiently understood. This study addresses this gap by examining the impact of socio-demographic and lifestyle-related factors on healthcare visits using a structured community health dataset comprising 1,000 observations. The objective is to assess the relative contribution of age and body mass index (BMI) to variations in healthcare utilization. The analysis employs exploratory data analysis, correlation assessment, and multiple linear regression modeling to evaluate associations and predictive effects. The results indicate that age is a statistically significant and dominant predictor of healthcare utilization, demonstrating a strong positive relationship with the number of visits, whereas BMI does not exhibit a significant effect. These findings suggest a disconnect between lifestyle-related health risk and actual engagement with healthcare services. The study highlights the importance of distinguishing between determinants of health risk and healthcare demand, emphasizing the need for age-responsive healthcare planning and strengthened preventive strategies. The findings contribute to improving evidence-based public health interventions and resource allocation in community health systems.
This study aimed to examine the impact of lifestyle behaviours and treatment interventions on mental health outcomes using a cross-sectional design. A total of 2500 participants from diverse demographic and socioeconomic backgrounds were included in the analysis. Data were collected on mental health status, lifestyle factors such as physical activity and sleep, and treatment interventions including therapy and medication. Descriptive and inferential statistical analyses were performed to assess associations between variables. The findings revealed that 35.08% of participants reported good mental health outcomes, while 30.84% reported fair outcomes, indicating a moderate overall mental health status within the population. Participants engaging in moderate to high physical activity and maintaining adequate sleep duration demonstrated better mental health outcomes compared to those with low activity levels and poor lifestyle patterns. Additionally, individuals receiving combined treatment interventions, including both therapy and medication, showed more favourable outcomes than those receiving a single form of treatment. The results suggest a significant association between healthy lifestyle behaviours, treatment engagement, and improved mental health. The study highlights the importance of integrating lifestyle modifications with clinical interventions to achieve optimal mental health outcomes. Despite limitations related to the cross-sectional design and self-reported data, the findings provide valuable insights for developing holistic and evidence-based approaches to mental health care
ASSESSMENT OF CLINICAL DETERMINANTS ASSOCIATED WITH MATERNAL HEALTH RISK
Maternal health risk assessment is essential for early identification of women who may require closer monitoring and timely clinical intervention during pregnancy. This study assessed clinical determinants associated with maternal health risk using routinely measurable clinical and physiological indicators. An observational analytical design was adopted using a maternal health dataset containing age, systolic blood pressure, diastolic blood pressure, blood glucose, body temperature, heart rate, and maternal health risk level. Data were screened for completeness, duplicate observations, and clinically implausible values. After data preparation, the final analytical sample comprised 451 records. Descriptive statistics, risk-category distribution, correlation analysis, and one-way analysis of variance were used to examine differences across low, mid, and high-risk maternal health categories. The results showed that low-risk cases represented 51.66% of the sample, while mid-risk and high-risk cases represented 23.50% and 24.83%, respectively. High-risk cases had higher mean age, systolic blood pressure, diastolic blood pressure, blood glucose, body temperature, and heart rate compared with low-risk cases. Blood glucose showed the strongest difference across risk categories, followed by systolic and diastolic blood pressure. All selected indicators differed significantly across maternal health risk groups. The findings suggest that routinely available clinical indicators can support maternal risk assessment and may assist early identification of women requiring closer antenatal monitoring.
GLOBAL DETERMINANTS OF HEALTH OUTCOMES: AN ANALYSIS OF RISK FACTORS, HEALTH SYSTEMS, AND DISEASE BURDEN
Global health outcomes are shaped by a complex interaction of environmental, behavioural, and health system factors. This study aims to analyze the determinants of health outcomes by examining the combined influence of risk factors, health system performance, and disease burden across countries. A cross-sectional analytical approach was adopted using secondary data from internationally recognized health databases, covering indicators such as life expectancy, mortality rates, noncommunicable diseases (NCDs), and healthcare access. The findings indicate that global health indicators improved significantly between 2000 and 2019, particularly in life expectancy and reductions in communicable diseases. However, these gains were disrupted during the COVID-19 pandemic, which led to a decline in healthy life expectancy. Noncommunicable diseases emerged as the leading cause of premature mortality globally, while communicable diseases remained prevalent in low-income regions. Strong associations were observed between environmental and behavioural risk factors and increased disease burden, whereas robust health systems were linked to reduced mortality and improved health outcomes. The study highlights significant disparities across regions and income groups, emphasizing the need for integrated and targeted public health strategies. Strengthening health systems and addressing modifiable risk factors are essential for improving global health outcomes and reducing inequalities
ANTIMICROBIAL RESISTANCE PATTERNS AND INFECTION CONTROL PRACTICES IN HOSPITAL-BASED CLINICAL SETTINGS
Antimicrobial resistance is a major threat to hospital-based healthcare because it increases treatment failure, prolongs hospitalization, and limits therapeutic options. Infection prevention and antimicrobial stewardship are essential for controlling the spread of multidrug-resistant organisms in clinical settings. This study aimed to assess antimicrobial resistance patterns and infection control practices in hospital-based clinical settings. A hospital-based cross-sectional descriptive study was conducted using two components: laboratory record review and healthcare worker assessment. Clinical specimens were reviewed to identify bacterial isolates and antimicrobial susceptibility patterns. Infection control practices were assessed among healthcare workers using a structured questionnaire and observation checklist. Data were analyzed using descriptive statistics, and resistance patterns were summarized by organism type, antibiotic class, and multidrug resistance status. A total of 420 clinical specimens were reviewed, of which 276 showed bacterial growth, giving a culture positivity rate of 65.7%. Gram-negative bacteria accounted for 71.7% of isolates. Escherichia coli was the most common pathogen, followed by Klebsiella pneumoniae, Staphylococcus aureus, Pseudomonas aeruginosa, and Acinetobacter baumannii. High resistance was observed against ampicillin, ceftriaxone, ciprofloxacin, and cotrimoxazole. Overall multidrug resistance prevalence was 50.0%, with the highest rate among A. baumannii. Infection control compliance was variable, with lower compliance for hand hygiene before patient contact and regular infection control training. The findings highlight a substantial burden of antimicrobial resistance and persistent infection control gaps. Continuous surveillance, hospital-specific antibiograms, improved hand hygiene, regular staff training, and integrated antimicrobial stewardship are recommended.
ANALYSIS OF HOSPITAL READMISSION RATES USING PREDICTIVE ANALYTICS FOR IMPROVED HEALTHCARE DELIVERY
Hospital readmission is a key measure of health care quality, safety and hospital performance. This study aimed to investigate hospital readmission rates using predictive analytics to determine which patients were at greater risk of readmission and help inform healthcare services. In this study used a structured hospital readmission dataset with 25,000 patients and 17 variables. Readmission was the dependent variable, with the independent variables being age, length of stay, number of laboratory tests, number of medications, number of outpatient visits, number of inpatient visits, number of emergency visits, medical speciality, diagnosis categories, glucose test, A1C test, medication change and diabetes medication status. There were no missing data or duplicate records in the dataset. Descriptive statistics revealed a readmission rate of 47.02% of patients, suggesting a high readmission rate. Machine learning models, such as Logistic Regression, Decision Tree and Random Forest were trained and tested based on accuracy, precision, recall, F1-score, and ROC-AUC. Random Forest emerged as the top model with the highest F1-score (0.5428) and Logistic Regression with the highest ROC-AUC (0.6434). Laboratory procedures, number of medications, time in hospital, age, diagnosis categories, medical speciality, and past inpatient visits were identified as important features in predicting readmission. The results indicate that predictive analytics can help hospitals identify patients at risk, plan discharge, organise follow-up care and allocate resources, which can lead to better patient-centred care.
CLINICAL AND HEALTHCARE UTILIZATION FACTORS ASSOCIATED WITH HOSPITAL READMISSION AMONG DIABETIC PATIENTS
Hospital readmission among diabetic patients remains a significant challenge for healthcare systems due to its association with increased clinical burden, healthcare costs, and reduced quality of care. This study aimed to examine the clinical and healthcare utilization factors associated with hospital readmission among diabetic patients. A quantitative analytical design was employed using a structured dataset comprising 25,000 patient records with variables related to demographic characteristics, clinical indicators, healthcare utilization, and readmission status. Descriptive and inferential statistical analyses were conducted to identify patterns and associations between study variables and hospital readmission. The results indicated that 47.02% of patients experienced readmission, highlighting a substantial readmission burden. Clinical factors such as age, primary diagnosis, medication use, and medication change were associated with variations in readmission rates. Patients with diabetes as the primary diagnosis and those undergoing medication adjustments showed relatively higher readmission levels. Healthcare utilization factors demonstrated the strongest association, with readmission rates increasing significantly among patients with higher numbers of prior inpatient, emergency, and outpatient visits. Additionally, longer hospital stays and higher healthcare utilization were observed among readmitted patients. The findings suggest that hospital readmission among diabetic patients is influenced by both clinical complexity and prior healthcare utilization. Identifying high-risk patients based on these factors can support targeted interventions, improve discharge planning, and enhance continuity of care. These insights contribute to evidence-based strategies aimed at reducing readmission rates and improving overall patient outcomes in diabetes management.
HEALTHCARE POLICY REFORMS AND THEIR INFLUENCE ON ACCESS TO AFFORDABLE MEDICAL SERVICES IN LOW- AND MIDDLE-INCOME COUNTRIES
Access to affordable medical services remains a major challenge in low- and middle-income countries (LMICs), despite growing policy commitments to universal health coverage, primary healthcare strengthening, and financial protection. Many reforms have expanded formal coverage, yet households continue to face out-of-pocket payments, medicine costs, transport expenses, and unequal service availability. This article examines how healthcare policy reforms influence access to affordable medical services in LMICs, with particular attention to health financing, universal health coverage, primary healthcare, equity, and implementation barriers. The study adopted a qualitative documentary research design using thematic analysis. Six secondary data sources published or updated between 2020 and 2024 were used, including reports and databases from the World Health Organization, World Bank, UNICEF, and the DHS Program. Data were extracted using a structured matrix covering reform type, access outcomes, affordability, financial protection, equity dimensions, and implementation challenges. The analysis identified six major themes: health financing reform, universal health coverage expansion, primary healthcare strengthening, affordability and financial protection, equity in healthcare access, and implementation barriers. Reforms improved access when they reduced direct payments, expanded pooled financing, strengthened frontline services, and targeted vulnerable populations. However, weak governance, inadequate funding, workforce shortages, medicine stock-outs, and rural-urban disparities limited effectiveness. Healthcare policy reforms can improve affordable access in LMICs when they combine financing reform, primary healthcare investment, and equity-focused implementation. Formal coverage alone is insufficient without financial protection and reliable service availability.
CLINICAL EVALUATION OF BIOCHEMICAL MARKERS IN HEPATITIS C AND ASSOCIATED LIVER DISEASES
Hepatitis C is a significant liver disease, which may progress from minimal hepatic inflammation to fibrosis and cirrhosis. Laboratory measures give valuable information about liver damage, dysfunction and disease progression. This research examined biochemical marker profiles in a Hepatitis C dataset of blood donors, hepatitis, fibrosis and cirrhosis cases. Biochemical markers, such as AST, BIL, GGT, ALB, CHE, CREA, ALT, ALP, CHOL and PROT were evaluated using descriptive statistics, group comparison, trend analysis, and cirrhosis deviation. Biochemical differences between groups were observed. The highest variation was observed in cirrhosis cases, with an increase in AST, BIL, GGT, and CREA and decrease in ALB and CHE compared to blood donor group. These suggest that severe liver damage is linked to multiple biochemical dysfunction related to liver cell damage, bile metabolism, decreased synthetic capacity, and potentially other systems. The research demonstrates the potential of biochemical profiling as a feasible and understandable means of evaluating the impact of Hepatitis C-associated liver disease. While conventional markers should not be used to diagnose liver disease, their integrated assessment may contribute to early identification, follow-up, and risk assessment of progressive liver disease.