This case highlights a rare, but important complication of varicella infection in children- septic vasculitis presenting with purpura and neurological signs and symptoms mimicking meningitis. Clinicians should be aware that in post-varicella period, bacterial superinfection can lead to systemic features including vasculitis and encephalopathy, even in the absence of classical Central Nervous System (CNS) infection markers. Early recognition and prompt initiation of antibiotics are crucial for a favorable outcome. In our patient, the purpuric rash and altered sensorium raised suspicion of meningococcemia, but normal cerebrospinal fluid (CSF) and Magnetic Resonance Imaging (MRI) findings, along with neutrophilic leukocytosis, elevated C-Reactive Protein (CRP) and a positive clinical response to antibiotics, supported a diagnosis of sepsis-associated vasculitis, likely secondary bacterial infection following varicella infection. Timely recognition and intervention by administering intravenous antibiotics led to complete resolution of the clinical condition in a short span.

Antimicrobial resistance (AMR) remains a critical challenge in elder care, where frequent infections, polypharmacy, and immunosenescence contribute to poor outcomes. Traditional diagnostic methods, including culture-based and polymerase chain reaction assays, often fail to provide timely, comprehensive microbial identification, leading to prolonged empirical antibiotic use and worsening resistance trends. Precision metagenomics, a clinically refined application of next-generation sequencing, represents a transformative advancement in infection diagnostics and antimicrobial stewardship. By enabling culture-independent, high-resolution pathogen detection directly from clinical samples, precision metagenomics provides real-time identification of bacterial, viral, fungal, and parasitic pathogens, along with their antimicrobial resistance profiles. This approach facilitates early intervention, improves therapeutic precision, and minimizes unnecessary antibiotic exposure, particularly in long-term care facilities where multidrug-resistant organism outbreaks are prevalent. Additionally, the integration of non-invasive sample collection methods, such as diaper-derived urine and hydrogel-based wound dressings, enhances diagnostic accessibility for frail and cognitively impaired patients. As sequencing costs decline and bioinformatics pipelines become more efficient, the routine implementation of precision metagenomics in elder care settings will transition infection management from a reactive to a proactive paradigm. The synergy between precision metagenomics, artificial intelligence-driven clinical decision support systems, and real-time biosensors presents a novel framework for infection surveillance, offering a sustainable solution to combat AMR while optimizing patient outcomes. This paper explores the clinical applications, challenges, and future directions of precision metagenomics in elder care, emphasizing its role in redefining infection control and antibiotic stewardship.

The present study evaluates the cystatin C, glomerular filteration rate (GFR) and vanillylmandelic acid (VMA) in comorbid diabetic and hypertensive patients attending Federal University Teaching Hospital, Owerri, Nigeria. A total number of 200 persons were recruited for the research; 50 controls, 50 hypertensive, 50diabetic, and 50 hypertensive-diabetic persons. The respondents were Federal Teaching Hospital, Owerri. Verbal consent was sort and questionnaires were used to extract information regarding biodata and patients’ history of diabetes and hypertension. Blood pressure was determined. A standard venepuncture method was used to obtain seven milliliters (7ml) of blood from all the subjects under asceptic conditions. 3milliliters was dispensed into a plain container capped, labeled appropriately and allowed to clot at room temperature. The serum were separated from the red cell by spinning at 4,000 r.p.m for 5minutes. The supernatant serum obtained were stored frozen at -20 0C until the day of analysis. The remaining 2ml of blood was dispensed into a fluoride oxalate container for the estimation of fasting blood glucose. 5ml of urine was collected into sterile universal bottle, then aliquot into cryovials and stored at -20oC till the day of assay. All reagents were commercially purchased and the manufacturer’s standard operating procedures was strictly adhered to. The fasting blood sugar levels was higher in diabetic-hypertensive group (199.50  25.36 mg/dl) and diabetic groups (209.85  19.95 mg/dl) compared to hypertensive (84.10  9.03 mg/dl) and control group (84.20  9.40 mg/dl). The mean value of the diastolic pressure of the diabetic-hypertensive group (102.90  6.87 mmHg) decreased which was statistically significant (P<0.05) when compared with the diabetic group (75.10  4.58 mmHg). The mean value of the systolic pressure of the diabetic-hypertensive group (160.00  7.36 mmHg) was decreased which was statistically significant (P<0.05) when compared with the diabetic group (115.30  6.14 mmHg). Serum creatinine increased in diabetic-hypertensive group when compared with other groups. The cystatin C levels was higher in hypertensive group (0.90  0.14 mg/l) and lower in diabetic-hypertensive group (0.84  0.17 mg/l) but the mean difference between the groups was not significant (P >0.05). The mean value of VMA was higher in diabetic-hypertensive group (12.48  2.25 mg/24hr) compared to diabetic (11.26  1.74 mg/24hr) and control (9.96 1.43 mg/24hr) group. There was decrease in the mean value of GFR of diabetic-hypertensive group (71.80  8.30 ml/min/1.73m2) which was not statistically significant (P>0.05) when compared with other groups. While there was an increase in GFR value of hypertensive group when compared with other groups. There was a positive correlation between creatinine and cystatin C (r = 0.337) and their association was significant (p<0.05). There was a negative correlation between creatinine and VMA (r = -0.164) and their association was significant (p<0.05). There was a negative correlation between creatinine and GFR (r = -0.558) and their association was significant (p<0.05). There was a negative correlation between cystatin C and VMA (r = -0.078) and their association was not significant (p>0.05). There was a positive correlation between cystatin C and GFR (r = 0.019) and their association was not significant (p>0.05). In conclusion, good control of blood glucose and blood pressure level reduces the likelihood of the development of renal impairment which is usually associated with both diabetes and hypertension. Co-morbidity of diabetes and hypertension poses a higher risk of developing renal disease. Both serum creatinine, cystatic C and GFR are important biomarkers for renal impairment hence should be monitored on a regular basis for diabetic and hypertensive patients and much more frequently for hypertensive-diabetic patients.

Objective: To assess the clinicians’ perspectives on GERD management and the prescription practices of proton pump inhibitors (PPIs) in Indian settings. Methods: This cross-sectional study was conducted among clinicians specialized in GERD management. Participants completed a 24-question questionnaire distributed via email or online platforms. The survey explored prescription practices, clinical observations, and preferences regarding PPIs and GERD management. Data analysis involved descriptive statistics, with responses presented as frequencies and percentages. Results: Out of 123 survey participants, 57% identified diet as the most common predisposing factor for GERD. Nighttime heartburn and disturbed sleep were recognized as key alarm symptoms by 57% of participants. Epigastric tenderness was the most prevalent physical finding, reported by 68% of clinicians. PPIs were favored as the first-line treatment for GERD by 78.86% of respondents. Domperidone was preferred as an adjunctive treatment for functional dyspepsia and gastroparesis. An empirical PPI trial was widely supported for its simplicity and cost-effectiveness. Rabeprazole emerged as the preferred PPI for nighttime heartburn relief due to its rapid onset and sustained efficacy. Conclusion: This study highlighted a consensus among Indian clinicians on the use of PPIs as a primary treatment for GERD, with a preference for rabeprazole. Domperidone is favored as an adjunctive treatment for functional dyspepsia and gastroparesis. Rabeprazole emerged as the preferred option for nighttime heartburn relief, owing to its rapid onset and long-lasting effectiveness.

Background: Colorectal malignancies are one of the commonest cancers throughout the world which is often diagnosed at advanced stages. Several lifestyle factors contribute to the development of this cancer such as a high intake of processed meats and low intake of fruits and vegetables, sedentary lifestyle, obesity, smoking and excessive alcohol consumption. Methods: This cross-sectional study was conducted in BIRDEM General Hospital in Dhaka in the Department of Pathology with 109 resected colectomy specimens during the period of March 2020 to February 2022. Relevant findings were recorded and analyzed for determining the morphological characteristics based on histopathological types, grading and staging of the malignancy. Results: Maximum patients belonged to 51-60 years of age; were males, hailing from urban regions and found to indulge in smoking. Per rectal bleeding, alteration of bowel habits and abdominal pain were the most frequently reported clinical symptoms. The commonest areas of occurrence of the tumors were rectum, recto-sigmoid junction and caecum. Out of all the 109 cases, 48, 45 and 16 belonged to non-mucinous, mucinous and signet-ring types as per histological classification respectively. Among these, 39 of non-mucinous and 24 of mucinous types belonged to Dukes’ B staging whereas 11 of the signet-ring variants fell in Dukes’ C stage. Regarding grading, maximum patients, meaning 68 out of 109, belonged to Grade II. After performing Fisher’s exact test, associations between staging and grading, grading and types and types and grading were found statistically significant. Conclusion: Colon and rectal mucin-secreting and signet-ring cell adenocarcinomas are high grade cancers that usually show up at an advanced stage.

Background: Although there were several clinical studies regarding the effectiveness of sitagliptin, there were dearth of studies on the prescription patterns and practices among clinicians. Methodology: This cross-sectional study included 19 statements with multiple responses in a pretested questionnaire format to gather and understand the current prescription practices, clinical observation and preferences for managing diabetes with a special reference to the clinical use of sitagliptin in Indian settings. The survey respondents were specialists with expertise in managing diabetes. Results: According to 49% of clinicians, the preferred drug combination for managing diabetes with hemoglobin A1C (HbA1C) levels >9% is dipeptidyl peptidase 4 inhibitors (DPP4i) + metformin + glimepiride. The majority of clinicians (89.92%) recommended sitagliptin as the preferred gliptin for cardiovascular (CV) protection in diabetic patients. Approximately 38% of clinicians considered established cardiovascular outcome trials (CVOT) and CV benefits as decisive factors in prescribing sitagliptin as a first- or second-line therapy for diabetic patients. Around 72% of clinicians preferred sitagliptin + dapagliflozin as an oral antidiabetic (OAD) combination for type 2 diabetes mellitus (T2DM) patients with chronic kidney disease (CKD). Approximately 42% of respondents reported sitagliptin + metformin as the preferred OAD combination, prescribed as a single pill, for uncontrolled T2DM patients with HbA1c levels >8%. Conclusion: The study highlighted the prescription trends favoring sitagliptin-based therapies in the management of diabetes, with potential cardiovascular benefits and as first- or second-line OAD therapy. The respondents also emphasized the significance of personalized approaches, such as the sitagliptin + dapagliflozin combination, for T2DM patients with CKD.

Acute appendicitis in the elderly is a difficult condition to diagnose and treat due to its atypical clinical presentation, the co-morbidities that these patients have and the risk of developing complications like perforation. The diagnosis involves the use of imaging modalities like computerized tomography and the treatment is by performing an appendectomy. Laparoscopic appendectomy is slowly becoming the gold standard in the surgical treatment of acute appendicitis in the elderly. We have conducted this review article to look at the diagnosis and management of acute appendicitis in the elderly. The role of laparoscopic appendectomy in the surgical treatment of acute appendicitis in the elderly is also investigated.