Indian Journal of Medical Sciences
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Item Navigating prognostic uncertainty in non-muscle invasive urothelial bladder cancer with focal squamous differentiation(Scientific Scholar, 2025-04) Shubhankar, G; Mittal, A; Panwar, VK; Tosh, JM; Mandal, AKObjectives: Transitional cell carcinoma (TCC), or urothelial carcinoma, represents the predominant histological type of bladder cancer. While the majority of TCC cases are characterized by conventional urothelial features, a significant subset exhibits variant histologies, such as focal squamous differentiation (SD). This variant is clinically noteworthy, given its association with more aggressive disease behavior and potential resistance to standard therapies, particularly intravesical Bacillus Calmette–Guérin (BCG) therapy. It raises critical challenges in prognosis and treatment. Materials and Methods: This single-center prospective cohort study enrolled patients with histopathologically confirmed TCC of the bladder, with or without focal SD, following transurethral resection of bladder tumor. Participants, devoid of deep muscle invasion and residual growth, received intravesical BCG therapy consisting of six weekly induction doses followed by 12 months of maintenance therapy. Outcomes were assessed through regular follow-up, utilizing clinical evaluations, imaging, urine cytology, and cystoscopy. The primary endpoints included recurrence-free survival (RFS), progression-free survival (PFS), and disease-specific survival (DSS). Results: Of the 131 patients evaluated, 35 exhibited focal SD. Statistically significant differences were observed between TCC with and without SD groups, with the former demonstrating poorer PFS (68.6% vs. 82.6%) and DSS (88.6% vs. 98%) after 1 year. However, RFS rates were comparable. Subgroup analysis revealed no significant differences in outcomes based on the extent of SD (>50% vs. <50%). Conclusion: Focal SD within TCC of the bladder portends a worse prognosis, particularly in terms of PFS and DSS, underscoring the necessity for tailored therapeutic approaches.Item Barriers and facilitators of human papillomavirus vaccination uptake in India: A systematic review(Scientific Scholar, 2025-04) Saran, AB; Gada, MB.Objectives Human papillomavirus (HPV) is a primary cause of cervical cancer, a major public health concern in India. Despite the availability of HPV vaccines, uptake remains suboptimal due to various barriers. This systematic review aims to explore the barriers and facilitators influencing HPV vaccination in India. Materials and Methods A systematic search of PubMed, Google Scholar, ScienceDirect, and Livivo databases was conducted following Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Inclusion criteria included studies from 2014 to 2024 that focused on HPV vaccination awareness, barriers, and facilitators in India. Data were synthesized narratively due to heterogeneity among studies. Results Thirteen studies were included. Key barriers identified were cost, lack of awareness, misinformation, and sociocultural factors. Facilitators included educational interventions, physician recommendations, and subsidized vaccination programs. School-based campaigns and community engagement were effective in improving vaccine acceptance. However, marginalized populations and out-of-school girls remain underserved. Conclusion Addressing economic and sociocultural barriers, enhancing awareness, and expanding targeted vaccination programs are essential to improve HPV vaccination rates in India. Aligning these efforts with the World Health Organization’s 90/70/90 strategy can significantly reduce the cervical cancer burdenItem Prognostic significance of programmed death ligand 2 expression in tumor-infiltrating lymphocytes of triple-negative breast cancer(Scientific Scholar, 2025-04) Ong, C; Jegannathan, N; Iqbal, J.Objectives: Triple-negative breast cancer (TNBC) is a highly aggressive subtype of breast cancer characterized by the absence of estrogen receptor (ER), progesterone receptor (PR), and overexpression of human epidermal growth factor receptor 2 protein. Patients with high expression of programmed death ligand 1 (PD-L1) and programmed cell death protein 1 (PD-1) have been found to have better prognosis and increased response to anti-PD-1/PDL1 immunotherapy. However, the role programmed death ligand 2 (PD-L2), the other known ligand of PD-1, plays in PD-1/PD-L1 checkpoint pathway has not been well studied. Therefore, this project aims to investigate (1) the relationship between PD-L2 expression in tumor infiltrating lymphocytes (TILs) and patient clinicopathological features, (2) whether PD-L2 can serve as a predictor of patient survival, and (3) the association of PD-L2 expression with the infiltration of relevant immune cell types in the tumor microenvironment. Materials and Methods: Two hundred and ninety-six (296) TNBC cases diagnosed between 2003 and 2013 in Singapore General Hospital were used in this study to create tissue microarray for immunohistochemistry with several antibodies. Results: Patients with PD-L2 expression were found to have significantly improved disease-free survival (hazard ratio [HR] 0.51; P = 0.0362) and overall survival (HR 0.43; P = 0.0379) compared to patients who have negative PD-L2 expression. PD-L2+ TILs correlate significantly with CD3+ T-cells (P = 0.00776) and CD20+ B-cells (P = 0.001019) infiltration in the stromal compartments and intratumoral CD38+ plasma cells (P = 0.048869) infiltration. Conclusion: Like PD-L1, PD-L2 positivity in TILs was found in our study to indicate a better prognosis compared to PD-L2-negative patients.Item Assessment of neutrophil-lymphocyte ratio, platelet-lymphocyte ratio, and mean platelet volume levels in oral squamous cell carcinoma and their correlation with histological grading and TNM staging(Scientific Scholar, 2025-04) Verma, R; Kumar, P.Objectives: The inflammatory response of the host plays a role in the prognosis of oral squamous cell carcinoma (OSCC). We studied the levels of neutrophil-lymphocyte ratio (NLR), platelet-lymphocyte ratio (PLR), and mean platelet volume (MPV) in OSCC patients and correlated them with TNM staging and histopathological grade to assess their role in prognosis. Materials and Methods: The study included 30 cases of OSCC and 30 controls. The mean NLR, PLR, and MPV of patients with OSCC were compared to the control group. Differences between different variables were analyzed using one-way analysis of variance test and unpaired t-test. Spearman’s rho test was used to determine the correlation between NLR, PLR, and MPV values in OSCC cases. Results: Mean PLR and NLR were higher, and mean MPV was lower in the OSCC group than in the control group. There was a statistically significant relationship between PLR and clinical TNM stage of cancer. Furthermore, there was a statistically significant relationship between PLR and NLR and histological stages of cancer. A statistically significant positive correlation between NLR and PLR was also observed. Conclusion: NLR and PLR, two inflammatory blood markers, have a significant prognostic impact on OSCC. MPV levels were not as important in predicting prognosis in OSCC as NLR and PLR. PLR and NLR are simple to incorporate into medical care and, when combined with other prognostic indicators, can help in the prognosis of OSCC.Item “Two tales of Frantz”: Varied presentations of solid pseudopapillary epithelial neoplasms of the pancreas(Scientific Scholar, 2025-04) Jacob, M; Bharathan, A; Balaraman, K; Venugopal, S.Frantz tumors or solid pseudopapillary epithelial neoplasms (SPEN) are rare pancreatic neoplasms seen in young, adolescent females, and rarely affect adult men. They are one of the most common pediatric pancreatic tumors and are most commonly seen in the distal pancreas (body and tail). Here, we present the two cases of Frantz tumor, of which the first is a classical presentation - SPEN tumor in the pancreatic body in a 9-year-old girl child, while the second is a rarer presentation in an adult male with the tumor located in the head of pancreas. Both patients presented with abdominal pain as their initial complaint and eventually underwent complete excision of the tumor. The contrasting features of the same tumor in both patients highlighted the need for us to report them as well as to review the tumor in general.Item Improving quality of life with sentinel lymph node biopsy in breast cancer patients – An overview(Scientific Scholar, 2025-04) Mahmood, AS; Al-Khazaali, YM; Abbas, AA; Ahmed, MS; Saleh, SA; Bani, Saad MA; Ismail, MBackground: Sentinel lymph node biopsy (SLNB) has emerged as a less invasive alternative to axillary lymph node dissection (ALND) for staging breast cancer (BC), offering significant reductions in morbidity. This review assesses the impact of SLNB on the quality-of-life (QoL) in BC patients compared to ALND. Methods: A comprehensive literature review was conducted using PubMed. The search phrase “(Breast cancer) AND (Sentinel Lymph Node Biopsy) AND (Quality of life)” identified studies comparing SLNB and ALND. A total of eight studies were included in the final analysis. A Preferred Reporting Items for Systematic Reviews and Meta-Analysis diagram illustrates the selection process. Results: The review found that SLNB is associated with significantly reduced rates of lymphedema and arm morbidity. Patients treated with SLNB reported better QoL scores in emotional functioning, pain management, and physical mobility compared to those treated with ALND. Conclusion: SLNB offers substantial benefits over ALND in terms of reducing post-operative complications and enhancing QoL in BC patients. These findings support the integration of SLNB into routine surgical management for eligible patients, emphasizing long-term patient welfare and functional outcomes.Item Babesiosis unmasked in chronic lymphocytic leukemia: A case report(Scientific Scholar, 2025-04) Kharel, H; Kharel, Z; Phatak, PDChronic lymphocytic leukemia (CLL)-related autoimmune cytopenias are common. Herein, we present the case of a patient with bicytopenia (anemia and thrombocytopenia), weakly positive direct Coombs test, and increased hemolytic markers. Cytopenias were initially presumed to be autoimmune and related to CLL. He was started on prednisone but to no effect. This prompted re-evaluation of peripheral blood smear which showed intra-erythrocytic inclusions. Considering the patient’s recent extensive hiking in tick-endemic areas and current residence in New York State, polymerase chain reaction for Babesia was performed, yielding a positive result. Treatment with atovaquone and azithromycin for 6 weeks resulted in a significant improvement in both cytopenias and hemolytic markers.Item Sentinel lymph node biopsy versus complete axillary dissection in breast cancer: Oncological outcomes and lifestyle improvements – An Iraqi perspective(Scientific Scholar, 2025-04) Mahmood, AS; Sfyyih, AN; Ahmed, HA; Hussein, RJ; Turkey, FA; Kamal, MS; Alhumaidi, AH; Al-Badri, SObjectives: To evaluate and compare the impact of ALND and SLNB on the oncological outcomes of BC patients. Materials and Methods: This is a prospective cohort study that included 160 patients with breast carcinoma who were scheduled to receive total axillary dissection. Patients were randomly assigned to undergo, together with breast surgery, either SLNB and ALND or SLNB followed by ALND only if the SLN was found positive. Follow-up included clinical examination every 4 months for the first 3 years, every 6 months for the following 2 years, and once a year thereafter. A mammography was scheduled annually. Results: After 6 months follow-up, eight types of complications were reported. In particular, lymphedema was reported in 4 women (5%) among sentinel LN group and 17 women (21.25%) in complete dissection group, with a highly significant difference. Collectively, 31 women (38.75%) among axillary dissection group had one or more complications compared with 17 women (21.25%) among sentinel LN group who had such complications with a significant difference. In multivariate analysis, each of older age (odds ratio [OR] = 2.62, 95% confidence interval [CI] = 1.24–10.86, P = 0.027), T2 tumor stage (OR = 11.3, 95% CI = 1.06–19.9, P = 0.044), and ALND (OR = 3.2, 95% CI = 1.12–5.31, P = 0.042) were significantly associated with increase the incidence of post-operative complications. Conclusion: SLNB is a highly efficient technique for evaluating the stage of the early BC. It is associated with less complication after surgery when compared to ALND. Increased post-operative complications in BC patients, whether handled with SLNB or ALND, are independently linked with advanced age and tumor stage.Item Readiness of undergraduate medical students to health research and factors influencing it in a medical college – A cross-sectional study(Scientific Scholar, 2025-04) Monisha, V; Rajini, S; Premnath, D.Objectives: Developing, maintaining, and sustaining undergraduate medical students’ research involvement will enable future healthcare practitioners to practice more appropriate evidence-based clinical medicine. This study aim to assess the readiness for health research and factors promoting it among Undergraduate medical students. Materials and Methods: A descriptive cross-sectional study was conducted among undergraduate medical students in Puducherry over 3 months (August–October 2023). Systematic random sampling was applied to recruit 360 study participants. A validated pre-tested semi-structured selfadministered questionnaire was used to gather data on sociodemographic, readiness, participation, attitude, perceived motivational factors, and barriers toward health research. Data were entered in MS EXCEL 2019 and analyzed using the Statistical Package for the Social Sciences v16.0. The quantitative variables were represented in mean and qualitative variables in proportion. Chi-square test and logistic regression analysis were applied to identify the factors influencing readiness to health research among undergraduate Bachelor of Medicine and Bachelor of Surgery students. Results: A total of 360 participants with a mean age of 20.7 ± 0.64 were recruited, demonstrating a nearly equal gender distribution (male 48.3% and female 51.7%). Approximately 76.4% scored ?60% in their recent university examinations, and 86.7% resided in hostels. While 11.4% reported prior participation in health research, 32.5% expressed readiness to participate, influenced by factors such as the competency-based medical education (CBME) approach and academic performance (P = 0.043). Major barriers identified included lack of funding (88.8%), lack of time (80.3%), and mentorship (52.9%). Logistic regression analysis revealed that higher examination grades significantly increased readiness to research (aOR: 1.936, P = 0.027) and also participation for health research (aOR: 3.366, P = 0.029), while non-CBME participants showed lower odds of participation (aOR: 0.321, P = 0.006). Conclusion: Medical institutes should implement structured mentorship programs, require research courses as part of the curriculum, and provide sufficient funding for student-led projects. Addressing these strategies within the institutes could foster a research-oriented culture, thus ultimately improve quality patient care and broader medical knowledge.Item National and international comparison of Turkish health system outcome indicators and policy recommendations(Scientific Scholar, 2025-04) Topakta?, G; Beylik, UObjectives: The study aims to analyze and make recommendations based on comparison of the results of the Turkish Health System both national and internationally. Materials and Methods: In the study, comments were made within the scope of trend analysis and comparison methods and discussed with the literature. The study data belonged to 2022 and were obtained from the Health Statistics Yearbook of the Ministry of Health, TURKSTAT, Organisation for Economic Co-operation and Development Health Data and EUROSTAT database. Average life expectancy, infant mortality rate, maternal mortality rate, satisfaction ratio with health-care services, and health expenditure impact data were taken into consideration. Results: There was poor performance internationally in terms of infant mortality rate and maternal mortality rate. There are extreme differences in these indicators between regions of Turkey. The level of patient satisfaction is well-positioned internationally. However, looking at its trend, it has entered a period of stagnation and decline. The increase in health expenditures in Turkey has also resulted in an increase in average life expectancy and patient satisfaction. Conclusion: It has been observed that Turkish’s health system is in the process of transition from middle-upper income group countries to upper-income group countries in terms of its results and performance, but the imbalances in access to service and health service quality between regions and the stagnating system produce negative results and cannot renew itself.Item Assessing ovarian cancer awareness and screening practices at Panjab University, Chandigarh(Scientific Scholar, 2025-04) Sharma, A; Puri, S; Sharma, MK.Objectives: Ovarian cancer (OC) poses a significant global health threat for women due to its high mortality rate and lack of reliable screening methods. It is often diagnosed at advanced stages, leading to poor outcomes. Empowering women with knowledge about risk factors and symptoms is essential for early detection and improved prognosis. Materials and Methods: A cross-sectional descriptive study was conducted among the female population of Panjab University, Chandigarh, including students, teaching, and non-teaching staff. Information on OC awareness was collected through a self-administered, structured, pretested, and validated questionnaire. Statistical analysis utilized proportions and the Chi-square test. Results: The survey revealed limited understanding of OC risk factors and symptoms among respondents. Overall awareness was low in both areas. In addition, a significant correlation was found between awareness of screening patterns and respondents’ occupations. Conclusion: There was a very poor knowledge about OC, its risk factors, symptoms, and screening patterns among females in university.Item Barriers to national accreditation board for hospitals and healthcare provider accreditation in public tertiary hospitals: A comprehensive review(Scientific Scholar, 2025-04) Kumar, N; Reddy, AN; Ramya, T; Rathod, PKIn India, the National Accreditation Board for Hospitals and Healthcare Providers (NABH) has become a well-respected framework that’s helped raise standards in many hospitals. Both private and public hospitals are now looking to get NABH accreditation, but public hospitals face a few challenge because they often deal with larger patient numbers and have limited resources. Public hospitals, especially big ones that serve a mix of different communities, tend to struggle with things such as old infrastructure and strict regulations. This review goes into these challenges, looking at the main obstacles that public hospitals face when they try to meet NABH standards. It covers areas such as money issues, lack of staff, and inefficiencies that make the accreditation process tougher. The review also suggests a few strategies and policy ideas that could help public hospitals push through these problems, with the goal of improving patient care across the board. By focusing on these challenges, this review hopes to give some useful insights to hospital administrators, policymakers, and the accreditation bodies working to make NABH standards a bit easier to achieve for all hospitals in India.Item Factors affecting the utilization of continuum of maternal healthcare services: Evidence from rural areas using Andersen-Newman behavioral model(Scientific Scholar, 2025-04) Chowdhury, S; Kasemi, NObjectives: This study examines the factors affecting the utilization of the Continuum of Maternal Healthcare Services (CMHS) in rural Purulia, West Bengal, focusing on full antenatal care (ANC), institutional delivery, and full postnatal care (PNC). Materials and Methods: A household survey using stratified multistage random sampling was conducted, collecting data on socio-demographic characteristics, healthcare access, and maternal healthcare utilization. Logistic regression analysis assessed associations between predisposing, enabling, and need factors with CMHS utilization. Results: Findings revealed that while 96% of mothers delivered in healthcare facilities, only 39% received full ANC and 44% full PNC, with an overall CMHS utilization rate of 25.74%. Factors influencing utilization included maternal and husband’s education, family structure, economic status, mass media exposure, and decision-making. Conclusion: The study highlights the crucial role of education, family structure, and socio-economic factors in determining CMHS utilization. Targeted interventions to improve maternal education, strengthen community health worker outreach, and enhance healthcare infrastructure are necessary to increase comprehensive maternal care in rural PuruliaItem Pulmonary paragonimiasis: Close mimic to pulmonary tuberculosis in endemic regions(Scientific Scholar, 2024-04) Sharma, S; Agrawal, G; Labru, V; Bhatt, AP; Ahmed, S; Bhatt, R.We, hereby, report a case of pulmonary paragonimiasis in a patient from an endemic region who was misdiagnosed with pulmonary tuberculosis as the clinical features of both diseases are the same. The subtle clue such as eosinophilia, food habits, and travel history can help us diagnose parasitic infections. Pulmonary paragonimiasis with coughing up rusty brown sputum is the most common presentation of the disease. Praziquantel is mainstay of treatment.Item A case of a 44-year-old lady presenting with Sheehan’s syndrome(Scientific Scholar, 2024-04) Bhandari, R; Paudyal, R; Khanal, A; Pandey, G.Because of ischemic necrosis following postpartum hemorrhage, patients with Sheehan’s Syndrome may exhibit different degrees of anterior pituitary insufficiency. They can report a variety of obscuring clinical signs and symptoms even many years after the postpartum hemorrhage, which could lead to a delay in diagnosis and an increase in mortality and morbidity. We report a case of a 44-year-old G3P3L3 lady who presented with this syndrome with history of postpartum hemorrhage 5 years back during the birth of her last child.Item Integration of hyperthermic intraperitoneal chemotherapy with cytoreductive surgery for ovarian cancer in Iraq: Navigating challenges in a resource-limited setting(Scientific Scholar, 2024-12) Mahmood, AS; Shakir, AA; Sabri, S.In Iraq, the application of hyperthermic intraperitoneal chemotherapy combined with cytoreductive surgery is a novel therapeutic strategy for ovarian cancer with peritoneal carcinomatosis. This study at the Arby Private Hospital represents the pioneering use of this modality in a resource-limited setting. It evaluates procedural effectiveness, elucidates the systemic challenges within the healthcare framework, and identifies the imperatives for medical training enhancement. The findings illuminate the clinical viability and outline necessary strategies for broader integration of advanced therapies into the Iraqi health-care paradigm, emphasizing a pressing need for policy and infrastructural reforms to elevate oncologic care.Item Florid vascular proliferation due to focal necrotizing enterocolitis in infancy: A case report(Scientific Scholar, 2024-12) Ozturk, S; Erdogan, Duzcu S; Boran, C; Ozturk, H.Vascular anomalies rarely emerge in the gastrointestinal tract. The most prevalent benign vascular lesions include angiodysplasia, Dieulafoy’s lesion, vascular ectasia, vascular malformations, and hemangiomas. Florid vascular proliferation (FVP) is also a rare benign vascular lesion associated with intussusception in adults. In infants, there are only a few cases in literature. Although FVP usually presents as a mass in the intestine, it is a non-neoplastic lesion and is thought to occur due to a reactive process. In this study, we present a case of FVP due to an attack of focal necrotizing enterocolitis in a 10-month-old infant.Item Gestational diabetes mellitus: Awareness, risk factors, perceived effects, and lifestyle intervention among pregnant women in a Nigerian tertiary health institution(Scientific Scholar, 2024-04) Chikeme, PC.Objectives: To assess the awareness, risk factors, perceived effects, and level of awareness of lifestyle interventions for the prevention of gestational diabetes mellitus (GDM) as well as the association between educational background and the level of awareness of GDM. Materials and Methods: A cross-sectional survey of 244 antenatal women was carried out using a validated self-administered questionnaire containing five sections with sections A to E bordering on demographics, awareness of GDM, risk factors, perceived effects on pregnancy, and lifestyle interventions towards prevention from May through August 2021. Data were analyzed using descriptive statistics of frequencies, percentages, means, and standard deviation. The chi-square test was used to assess the association between educational background and level of GDM awareness. Results: Out of 244 respondents who showed awareness of GDM, 212 (86.9%) had an understanding of what GDM is, 212 (86.9%) knew the risk factors, 227 (93.0%) agreed that they knew the effects, 191 (78.3%) knew about lifestyle interventions. Despite the positive responses, disparities exist in their levels of awareness of each alleged variable. There was an association between educational background and level of awareness of GDM with a P-value of 0.0001 (<0.05). Conclusion: The majority of antenatal women were aware of GDM, risk factors, effects, and lifestyle interventions with diverse degree levels. Less than half were fully aware of the risk factors, and the effects on pregnancy. Regular health/medical professional visits were the most acceptable lifestyle intervention for the prevention of GDM. There was a significant association between education and the level of awareness of GDM. Thus, the government is to enact strong policies that will favor female education as education is a strong determinant of awareness of disease conditions.Item The orthopedics and sports medicine research in India from 2013 to 2022: Comparison with South Asia, European Union, China, and USA(Scientific Scholar, 2024-12) Hassan, W; Duarte, AE.Objectives: In the present study, we explored the research progress in Orthopedics and Sports Medicine within India and South Asia from 2013 to 2022. Materials and Methods: In November 2023, the data were retrieved from Scopus databases. Key indicators such as the number of publications, citations, citations per paper, field-weighted citation impact (FWCI), and distribution across journal quartiles were analyzed. Results: While India demonstrated a substantial contribution to the field, comparative analysis revealed it lags behind China, Europe, and the USA in both quantity and quality of research output. Specifically, India (6,498) and South Asia (6,983) exhibit lower scholarly outputs as compared with China (30,350), European Union (EU) (105,228), and the USA (100,041). Citations per publication reveal gaps, with the USA leading (17), followed by the EU (15.5), China (7.7), and India (7.6). FWCI placed the USA at 1.22, EU at 1.2, and lower values were noted for South Asia (0.74), India (0.70), and China (0.69). Conclusion: The distribution across quartiles indicated that India and South Asia’s comparatively lower emphasis on Q1 (21.30% and 21.72%, respectively), while the EU, China, and the USA demonstrated higher proportions (49.29%, 27.07%, and 53.05%). Conversely, in Q4, India and South Asia (15.04% and 14.87%) have higher concentrations, signaling a potential area for improving research quality. Recommendations include increased funding, interdisciplinary collaboration, investment in advanced technologies, and a focus on high-impact journals.Item Association of serum iron and serum calcium levels in children with febrile seizures(Scientific Scholar, 2024-04) Gupta, H; Sharma, B; Verma, M; Singh, VK; Verma, R.Objectives: The current case–control study was conducted to investigate the relationship of iron deficiency anemia and calcium levels with febrile seizures (FSs) in children. Materials and Methods: The study included 200 children ranging in age from 6 to 60 months. One hundred cases had FSs, including simple FSs and rest; 100 controls had a short history of febrile illness (<3 days) without seizures. A statistical analysis of the data was carried out using Statistical Package for the Social Sciences version 23. Results: The mean weight, height, and head circumference of cases and controls are 9.73 ± 2.51 kg and 10.63 ± 3.34 kg, 79.66 ± 11.08 cm and 85.43 ± 15.55 cm, and 46.37 ± 2.79 cm and 46.83 ± 3.72 cm, respectively. As per the Indian Academy of Pediatrics, 27% of cases and 37% of controls had protein energy malnutrition (PEM). In cases and controls, the mean hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width values were 9.23 ± 1.30 and 10.78 ± 1.60 gm/dL, 68.83 ± 8.86 and 78.59 ± 9.82 fl, 25.40 ± 3.47 and 28.50 ± 3.60 pg, and 18.73 ± 1.77 and 16.44 ± 1.76, respectively, and are statistically significant. Patients had lower serum ferritin levels than controls. The mean blood calcium levels in cases and controls were 9.13 ± 0.64 and 9.05 ± 0.93 mg/dL, respectively (P = 0.507). Iron deficiency anemia was found in 26% of cases and 7% of controls (P value <0.001). Hypocalcemia was reported in only 18% of patients and 23% of controls (P = 0.38). Conclusion: There is a clear correlation between FSs and iron deficiency. The majority of data suggests that hypocalcemia is unlikely to be the cause of FSs. Early detection and intervention of iron deficiency in children could help in the prevention and recurrence of FSs.