Annals of the National Academy of Medical Sciences (India)
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Editor: Dr. Sanjeev Misra
ISSN: 2454-5635
Frequency: Quarterly
Language: English
Open Access Peer-reviewed journal
Web site: https://annals-nams.in
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Item Unmasking molluscum contagiosum: Navigating atypical presentations in a clinical mosaic(National Academy of Medical Sciences, 2025-03) Ahuja, S; Sharma, P; Zaheer, S.Molluscum contagiosum is a poxvirus-mediated, highly contagious infection predominantly affecting the face, trunk, and extremities of children and young adults. Although typically characterized by flesh-colored papules with central umbilication, atypical presentations, particularly in immunosuppressed and HIV-infected individuals pose diagnostic challenges. This retrospective study, spanning from January 2013 to January 2016, examined 19 cases of molluscum contagiosum, emphasizing unusual clinical and histopathological features. Three atypical cases were identified, including a 24-year-old female with a subcutaneous lump on the left areola, a 34-year-old male with genital lesions resembling lichen nitidus, and a 17-year-old male with a cystic scalp swelling. Histopathological examination confirmed molluscum contagiosum in all cases, revealing characteristic eosinophilic inclusions within squamous cells. Notably, the study expands the understanding of atypical presentations, such as lesions on the areola and cystic forms, which are infrequently reported in the literature. Despite the absence of immunosuppression or HIV infection in the atypical cases, the study highlights the need for clinicians to consider molluscum contagiosum in diverse clinical scenarios. The accurate diagnosis, often requiring biopsy or cytology, underscores the importance of histopathological evaluation in guiding appropriate treatment strategies, including surgical excision or topical antiviral agents. Overall, these case reports contribute valuable insights into the varied manifestations of molluscum contagiosum, emphasizing the necessity for vigilance in recognizing atypical presentations.Item Case of congenital mandibular malformation: A rarity(National Academy of Medical Sciences, 2025-03) Arumugham, D; Sadaksharam, J; Jayaram, V.The condition known as craniofacial duplication, or Diprosopus, is an exceedingly rare occurrence. The term “Diprosopus” originates from Greek, meaning “two-faced person.” This condition can involve a wide range of anomalies, from complete duplication of facial features to partial duplication of specific facial structures. It is a congenital developmental abnormality typically identified during prenatal development or in the early stages of a child’s growth. Formerly, it was believed to be an anomaly rather than a teratoma. The first documented report of this unique phenomenon was by Mclaughlin in 1948, and it was also recognized as a form of conjoined twinning. The classification system for this condition is based on the specific structures that exhibit duplication, resulting in four distinct types. Notably, this report discusses an extraordinary case involving the irregular growth of the mandible in a seven-year-old girl. This case is marked by the growth of an accessory structure stemming from the lower border of the mandible and is associated with developing tooth buds. The report delves into the diagnosis and management of such a unique and complex case.Item Summary of initiatives for treating congenital heart disease: Enhancing quality of life and bridging the knowledge gap(National Academy of Medical Sciences, 2025-03) Ahamad, S; Kukshal, P.Congenital heart disease (CHD) represents a significant global health concern, contributing to high infant mortality rates, particularly in low and middle-income countries (LMICs) like India. The primary obstacles that need to be addressed include low awareness, delayed diagnosis and referral, unavailability, inaccessibility, and unaffordability of essential medical care, high patient volumes, lack of dedicated research, and widespread malnutrition. In this web-based literature review, we aim to highlight the critical gaps in healthcare access for CHD by summarizing the disease burden and identifying organizations and initiatives that offer free cardiac interventions throughout India.Item Congenital scoliosis: What is new in the present decade?(National Academy of Medical Sciences, 2025-06) Tsirikos, AI.Congenital anomalies of the spine occur due to faults in the embryological development of the immature vertebrae as an isolated defect or in association with a systemic condition. The result of the presence of these abnormalities is an asymmetrical growth affecting the longitudinal development of the spine and often producing an aggressive deformity involving the coronal and/or the sagittal planes. Recognition of the anatomical nature of the vertebral anomalies, their location along the spine and relationship to adjacent levels can predict the risk of deformity development and curve deterioration. Treatment is recommended at an early stage for those vertebral defects that are likely to produce a progressive deformity. The key to successful treatment in congenital spinal deformity is to diagnose in a timely manner those patients who are at risk to develop a severe deformity and apply early, prophylactic surgical treatment when the associated risks of major complications are more limited.Item A rare incidence of malignant pleural effusion in multiple myeloma(National Academy of Medical Sciences, 2025-03) Boddu, R; Singh, K; Saxena, P; Pattanayak, S; Kumar, S; Mishra, K.Multiple myeloma (MM) is one of the most common hematological malignancies. The incidence of pleural effusion (6%) as such is rare in patients with MM, and the incidence of myelomatous pleural effusion is even rarer (1%). The timely diagnosis of this entity is very important because these individuals have a poor overall prognosis. Diagnosis can be made by careful examination of pleural fluid cytology and can be confirmed by flow cytometry. We report a case of myelomatous pleural effusion diagnosed early and successfully managed.Item Vilanterol vs formoterol in obstructive airway diseases: A comprehensive review of efficacy, safety, and clinical advantages in light of Global Initiative for Asthma 2024 and Global Initiative for Chronic Obstructive Lung Disease 2024 guidelines(National Academy of Medical Sciences, 2025-03) Garg, R.This comprehensive review evaluates the comparative efficacy, safety, and clinical advantages of vilanterol versus formoterol in the management of obstructive airway diseases, with a specific focus on the latest Global Initiative for Asthma (GINA) 2024 and Global Initiative for Chronic Obstructive Lung Disease (GOLD) 2024 guideline recommendations. Vilanterol, a novel long-acting ?2-agonist (LABA), demonstrates a 24-hour duration of action, allowing for once-daily dosing, compared to formoterol’s twice-daily requirement. Clinical trials in both asthma and chronic obstructive pulmonary disease (COPD) have shown vilanterol-containing combinations to be at least as effective as formoterol-based treatments in improving lung function, symptom control, and quality of life. However, the GINA 2024 guidelines emphasize formoterol’s role in as-needed and maintenance and reliever therapy (MART) approaches for asthma management. In COPD, vilanterol aligns well with GOLD 2024 recommendations, particularly in fixed-dose combinations. Safety analyses indicate a favorable profile for vilanterol, even in high-risk populations. The once-daily dosing of vilanterol offers potential improvements in patient adherence and satisfaction, especially relevant in COPD management. While direct cost comparisons are limited, improved clinical outcomes suggest potential cost-effectiveness benefits. This review concludes that while vilanterol presents several advantages, particularly in COPD management and once-daily regimens, the choice between vilanterol and formoterol should be individualized based on patient characteristics, disease features, and current guideline recommendations.Item Disaster management knowledge and practices among nurses: A cross-sectional study(National Academy of Medical Sciences, 2025-03) Aggarwal, A; Sharma, R; Tej, KM; Chawla, D.Objectives: Disasters significantly disrupt human life and societal structures worldwide, necessitating robust disaster preparedness systems. Nurses play a crucial role in disaster response; however, ongoing training and specialized skills are essential due to the dynamic nature of these events. This study aims to address the lack of data on nurses' perceptions of disaster education and preparedness. Understanding these perceptions is vital for improving nursing education and enhancing the effectiveness of disaster response. Material and Methods: An observational cross-sectional study was conducted with a sample of 60 nursing staff working in the OPD, emergency, and ICU wards of Guru Teg Bahadur (GTB) Hospital in Delhi. A self-administered questionnaire on knowledge and practices related to disaster man- agement was provided to the participants, and their responses were recorded. The questionnaire consisted of three sections: questions pertaining to participant and baseline information, knowledge, and practices. Additionally, there was a separate section for participants to offer suggestions on how to improve their knowledge and practices. Results: The results indicated a significant level of awareness and knowledge (70.9%) among the participants regarding disaster management. However, notable gaps exist in specific expertise and experience related to disaster preparedness and response. It was observed that only 32 participants (53.3%) regularly or occasionally participated in disaster drills, highlighting a lack of practice among them. Conclusion: The assessment of disaster management practices among hospital staff revealed both strengths and areas for improvement. While there is a general awareness and understanding of disaster management principles, gaps in practical engagement and procedural knowledge remain. There is a strong consensus on the need for more workshops and simulated training. To address these issues, it is essential to implement regular mandatory drills and enhance training programs. These measures will help hospitals cultivate a more resilient workforce capable of effectively responding to disasters and ensuring the safety of patients and the community.Item Assessment, localization of hearing loss and rehabilitation in children with cerebral palsy(National Academy of Medical Sciences, 2025-03) Mathur, NN; Narang, E.Objective: This study was designed to assess hearing loss in children with cerebral palsy (CP) using brainstem evoked response audiometry (BERA), otoacoustic emissions (OAE), pure-tone audiometry (PTA), and impedance audiometry. The prevalence of hearing loss was studied in this group and the location of lesion causing hearing loss was found using the above tests. We also compared the efficacy of OAE and BERA as screening modality for the detection of hearing impairment in such children. Material and Methods: The study was conducted on 100 patients (200 ears) with CP in the age group of 1–18 years. The patients were selected randomly from those presenting to the Outpatient Department (OPD) with a diagnosis of CP in Kalawati Saran Children’s Hospital. Investigations like BERA, transient evoked OAE (TEOAE), distortion product OAE (DPOAE), PTA, and impedance audiometry were done on them. Results: On BERA, 58.5% children passed as per our criteria, and 41.5% failed the test. In all, 78% cases showed abnormal morphology of wave V. More than 50% of those who passed on BERA had poor morphology of wave V. Latency of wave V at 80 dB was prolonged in most cases. The mean latency of wave V was 6.159 msec. About 83.5% children failed on OAE testing according to our criteria, while only 16.5% passed. Conclusion: The prevalence of hearing loss was calculated to be 41.5%. In most cases, the site of the lesion was found to be cochlea, as OAE was absent in most cases (83.5% of patients tested). OAE was found to be a less efficacious test as compared to BERA in detecting hearing loss.Item A five-year review of in-hospital neonatal mortality: Trends and implications for care(National Academy of Medical Sciences, 2025-06) Gupta, P; Garg, D.Objectives: The objectives of this study were to estimate the in-hospital mortality/survival outcomes at discharge and to determine the risk factors for in-hospital neonatal mortality. Material and Methods: This study was a secondary data analysis (review) of the existing hospital records during the first five years of operationalization of the neonatal intensive care unit (NICU) in a tertiary care hospital at Haryana, India. Results: There were 126 in-hospital mortality rates among a total of 2725 admissions (i.e., in-hospital neonatal mortality of 4.62 per 100). The in-hospital mortality among male and female neonates were comparable (4.52 vs 4.26%; P value 0.788). However, the in-hospital mortality among extramural births (5.52%) was significantly higher than the mortality among intramural births (4.26%; P = 0.010). Neonates with the lowest birth weight had the highest in-hospital mortality (P value < 0.00001). There was an exponential increase in the risk of in-hospital mortality among neonates with birth weight < 1500 g and < 1000 g, that is, 11.6% and 48.6%, respectively. Conclusion: Information about in-hospital neonatal mortality and survival outcomes from NICU is an important indicator of quality of care. The in-hospital mortality in this study was comparable to other Indian studies, with poorer survival outcomes among neonates < 1500 g birth weight. Extra- mural births had higher mortality than intramural births, reminding us of the importance of in-utero fetus transfer among high-risk and preterm labor.Item Safety and efficacy of TightRail mechanical sheath for transvenous lead extraction(National Academy of Medical Sciences, 2025-06) Bohra, V; Aggarwal, N; Keshavamurthy, G; Guleria, V; Singh, B.Objectives: This study aimed to evaluate the safety and efficacy of the bidirectional rotational mechanical sheath TightRail (Spectranetics Corp., Colorado Springs, CO, USA) for lead extraction in an Indian center. Material and Methods: A prospective study of patients who underwent transvenous lead extractions (TLE) in whom manual extraction was ineffective during the period from March 2018 to March 2021. Results: A total of 28 patients underwent lead extraction using TightRail. The mean age at the time of extraction was 62.4±18.07 years. The average duration between implantation and extraction was 8.8±4.6 years. The most common etiology was pocket site infection (78.6%), followed by lead endocarditis (7.1%), chronic pain (3.6%), and lead fracture (10.7%). In total, 53 lead extractions were attempted, with 51 procedures, resulting in a clinical success rate of 96.2%. Approximately 7.14% patients required blood transfusions, and 3.6% developed pericardial effusion. There was no incidents of cardiac avulsion, death or arrhythmias requiring cardioversion. Conclusion: This extensive clinical study in India demonstrated that the use of TightRail provides high safety and efficacy for lead extractions across a wide range of lead age. The incidence of infectious etiology was found to be much higher in Indian patients compared to Western literature.Item The link between serum vitamin D levels and bronchial asthma: A case control study(National Academy of Medical Sciences, 2025-06) Kumar, PN; Amirullah, A; Kumar, D.Objectives: Asthma is a common long-term respiratory condition that considerably increases morbidity worldwide. Because of its immunomodulatory properties, vitamin D may have an impact on the severity of asthma. This case control study explores the relationship between serum vitamin D levels and bronchial asthma. Material and Methods: There were 70 participants in all, 35 of whom were matched controls and 35 of whom were asthma patients. Measurements of IgE and serum vitamin D were made to look for associations with asthma. Results: Patients with asthma had higher IgE levels, suggesting heightened allergic reaction and substantially less vitamin D in their blood (13.83 ± 9.34 ng/mL) than control (27.34 ± 8.19 ng/mL) (p < 0.001). Conclusion: This study highlights that individuals with bronchial asthma tend to have lower serum vitamin D levels and higher IgE levels, suggesting a link between vitamin D deficiency and asthma severity. Addressing vitamin D deficiency may offer a supportive role in asthma management, though further studies are needed to confirm these findings.Item Prevalence of various fungal infections among HIV/AIDS patients(National Academy of Medical Sciences, 2025-06) Kumari, N; Malhotra, S; Chauhan, AK; Chauhan, N; Bhatia, NK.Objectives: Human immunodeficiency virus (HIV)-associated opportunistic fungal infections (OFI) are a major cause of mortality and morbidity in HIV-seropositive patients. This prospective study aimed to isolate various fungal pathogens from HIV seropositive patients and to identify and characterize these fungal pathogens at the species level in India. Material and Methods: Based on clinical signs and symptoms, various clinical specimens (n=323) were collected from (n=200) HIV-seropositive patients in the adult age group of either sex and underwent direct microscopy and fungal culture. Fungal isolates were identified and specified according to a standard protocol. Statistical analysis: All data were collected and analyzed using Microsoft Excel. Results: Out of 323 samples from 200 HIV-seropositive patients with a suspected fungal infection, fungal isolates were found in 89 cases, or 27.56% of cases. The most frequently isolated fungal organism was Candida species (75.28%), followed by Cryptococcus neoformans (17.97%), Aspergillus species (4.48%), Alterneria species (1.12%), and Trichophyton mentagrophyte (1.12%). Amongst 67 Candida species, Candida albicans had the highest isolation rate (88.05%), followed by Candida tropicalis (5.97%), Candida parasilosis (2.98%), and Candida auris (2.98%). Conclusion: Oropharyngeal candidiasis followed by cryptococcal meningitis was the most common OFI among other fungal infections. This study would help clinicians in the proper diagnosis and early treatment of these infections to prevent their devastating effects in developing countries like India.Item Assessment of radiation exposure: An in-depth analysis of dose evaluation in contrast-enhanced computed tomography abdomen imaging(National Academy of Medical Sciences, 2025-06) Aryal, B; Bhat, MR; Wani, AA; Islam, JU.Objectives: The advancement of diagnostic imaging highlights the critical role of computed tomography (CT) scans in disease diagnosis. contrast- enhanced computed tomography (CECT) abdomen is widely utilized for detailed visualization of abdominal structures. However, it entails exposure to ionizing radiation, raising concerns, particularly regarding cancer risk. The radiation dose from CECT varies based on scan parameters, patient size, and imaging protocols. Medical professionals aim to optimize scanning parameters to minimize radiation exposure while preserving diagnostic quality. The objective of this study was to assess the variance in estimated doses received during CECT abdomen scans. Material and Methods: Data from patients undergoing CECT abdomen from March 2023 to March 2024, including volumetric CT dose index (CTDIvol) and dose length product (DLP), were analyzed by a medical physicist and Radiation Safety Officer. Mean and cumulative doses were calculated using CTDIvol and DLP, with the effective dose determined using total DLP and a k-factor of 0.015 for the abdomen. Results: This study comprised 296 patients (211 males and 85 females), primarily presenting with abdominal symptoms, with an age range of 18–85 years. Mean CTDIvol varied from 5 mGy to 26.42 mGy in males and from 4.96 mGy to 21.9 mGy in females, with similar trends observed in DLP values and effective doses. Statistical analysis indicated no significant difference in radiation dose by sex, though variations in effective dose were noted, possibly due to differences in exposure parameters and patient demographics. Conclusion: While CECT scans effectively diagnose abdominal conditions, they do pose radiation risks. Radiology departments should monitor doses, standardized protocols, refine imaging techniques, and collaborate to ensure safety. Diagnostic reference levels are crucial for balancing the need for diagnostic information with the necessity to minimize patient exposure to radiation.Item Medication adherence and quality of life in gestational diabetes mellitus: A comprehensive review(National Academy of Medical Sciences, 2025-03) KV, Nishma; T, Nikhila; KP, Shibila; M, Shamila; VP, Baseema.Gestational diabetes mellitus (GDM) is an increasingly significant public health issue with serious implications for both maternal and fetal health. This comprehensive review seeks to explore the factors that affect medication adherence and quality of life (QoL) among pregnant women with GDM in India. We conducted a systematic search of peer-reviewed literature published between 2019 and 2024, utilizing PubMed, Scopus, and other relevant databases. Key findings indicate that the prevalence of GDM in India is on the rise, with recent studies estimating a national prevalence of 13%. Factors that influence medication adherence include patient education, socioeconomic status, and the complexity of treatment. Additionally, the QoL for GDM patients is impacted by social support, knowledge about the condition, and various clinical factors. Our review highlights the necessity for standardized screening protocols, personalized patient education, and comprehensive management strategies to enhance medication adherence and QoL for those with GDM.Item Celiacomesenteric trunk � A not so common variation(National Academy of Medical Sciences, 2024-10) Panwar, R; Nair, AS; Athindranath, T; Adibatti, M; Krishnamurthy, A.The Coeliac trunk is the first ventral branch of the abdominal aorta and is the artery of the foregut, which supplies the derivatives of the foregut i.e., oesophagus, stomach, liver, gallbladder, pancreas, and the second part of the duodenum, up to the level of the opening of the major duodenal papilla. The superior mesenteric artery is the next branch of the abdominal aorta, which arises most commonly at the level of the first lumbar vertebra and supplies embryonic derivatives of the midgut i.e., from the second part of the duodenum (below the level of major duodenal papilla) to the proximal two-thirds of the transverse colon. Sometimes coeliac trunk and superior mesenteric artery arise as a common celiacomesenteric trunk. The embryological basis of celiacomesenteric trunk is discussed in the current case report. Also, the clinical significance of celiacomesenteric trunk in various conditions is described. During complex interventional procedures, this type of variation must be looked at carefully in radiological images to reduce the chances of postoperative complications.Item Osteocartilaginous choristoma of palatine tonsil: A rare entity(National Academy of Medical Sciences, 2024-10) Batra, A; Dhingra, S; Pujani, M; Khandelwal, A; Singh, K.Choristoma is the presence of normal tissue in an abnormal anatomical location. The presence of mature cartilage in the tonsil represents a choristoma as it is not a normal constituent of the tonsil and is a very rare entity. More than 70% of lingual choristomas occur in females; the tongue is the most common site, accounting for 80% of the cases. Osseous choristoma of the tongue is a rather rare entity, with less than 100 cases reported in the literature. We hereby report an osteocartilaginous choristoma of the palatine tonsil in a 42-year-old male patient who presented with a sore throat and difficulty in swallowing, for which he underwent tonsillectomy. Choristoma was an incidental discovery. Histopathology features were consistent with chronic tonsillitis along with incidental occurrence of hyaline cartilage and bone. As choristoma is a benign tumor that usually does not require any further treatment after simple excision, therefore no further treatment was given. The patient is currently under a 2- year follow-up and does not show any signs of recurrence. This case creates awareness about this rare entity among pathologists and clinicians so that overzealous and unnecessary treatment is avoided.Item DPI: A paradigm shift from nebulizers to dry powder inhalers(National Academy of Medical Sciences, 2024-10) Patil, PS; Mahajan, HS.Drug delivery to pulmonary routes was once considered a challenging task. The emergence of inhalation therapy paved the way for drug delivery to the lungs. With various advances in inhalation therapy, modern-age drug delivery systems include nebulizers, pressurized metereddose inhalers, and dry powder inhalers (DPIs). The following review discusses the development stages of DPIs and also gives an insight into the current formulation aspects of DPI, animal models used for evaluation of drug release parameters, and the Anderson cascade impactor and its possible correlation with human respiratory tract with regards to drug deposition and particle size. Today, DPIs have brought about a revolution in drug delivery to lungs, and also offer more advantages with regards to consistency of dose delivered, stability, and ease of administration. Dry powders have been extensively used in the treatment of asthma and various other respiratory disorders. With the introduction of nanoformulations, a wide sector of researchers is working toward developing DPIs that may be used to target diseases like lung cancer.Item Association of circulatory chemerin levels with the severity of pre-eclampsia: A systematic review and bootstrapped meta-analysis(National Academy of Medical Sciences, 2024-10) Varikasuvu, SR; Madhuri, M; Ali, A; Gowtham, K; Jegatheesan, J; Ranjan, A; Kumar, A; Kumari, B; Tiwari, M; Sharma, S.Introduction: This study presents a systematic review and meta-analysis to investigate the association between circulating chemerin levels and the severity of preeclampsia (PE). Material and Methods: A thorough search was conducted across multiple databases, including PubMed/MEDLINE, SCOPUS, and the Cochrane Library, up to March 31, 2024, focusing on observational studies that compared chemerin levels in patients with severe versus mild PE. Two independent reviewers extracted mean and standard deviation (SD) values of chemerin levels from these studies. The quality and risk of bias of the included studies were assessed using the Newcastle朞ttawa Scale. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to evaluate the difference in chemerin levels between severe and mild PE groups. Sensitivity analyses were performed to address heterogeneity and ensure the reliability of the findings. Additionally, a bootstrapped meta-analysis with 1,000 and 10,000 simulations was conducted to further validate the results. Results: Six observational studies were included in the analysis. The findings revealed that patients with severe PE had significantly higher chemerin levels compared to those with mild PE (SMD 1.55, 95% CI 0.67�43, p < 0.0001). The bootstrapped meta-analysis supported the accuracy of these findings (SMD = 1.54, CI = 0.74�38). No publication bias was identified using Begg抯 and Egger抯 tests, and the sensitivity analysis confirmed the robustness of the results. Conclusion: This meta-analysis provides compelling evidence that chemerin levels are significantly elevated in patients with severe PE compared to those with mild PE. Further research is warranted to investigate the potential of circulating chemerin as a diagnostic marker for PE severity.Item Modulation of sleep quality, cardiac autonomic activity, and cognition by yoga in medical students(National Academy of Medical Sciences, 2024-10) Mishra, P; Singh, A; Agarwal, P; Mathur, MK; Bhandari, B.Objectives: The disturbed sleep quality among medical students due to their hectic schedule may negatively impact the cognition, consequently affecting their academic performance. With the hypothesis that short duration of simple yogic exercises may improve sleep quality and heart rate variability (HRV), and thus may improve cognitive abilities, the study aims to evaluate the outcome of short duration yoga training on HRV, cognition, and sleep in medical students. Material and Methods: The participants of the study were young and apparently healthy medical students. The study commenced after the Institutional Scientific Re- search and Ethics Committee approval. The informed consent was taken from all the participants in writing. All parameters (height, weight, age, body mass index [BMI], systolic blood pressure [SBP], diastolic blood pressure [DBP], heart rate [HR]) along with HRV, sleep quality (using Pittsburgh Sleep Quality Index [PSQI]), and cognitive ability (using Trail Making Tests Parts A & B [TMTs-A&B]) were assessed in the participants at baseline. Thereaf- ter, the students practiced yoga (asanas, pranayama, and meditation) under supervision of a yoga instructor and a faculty for the duration of one hour every day for six weeks. Measurements were repeated after six weeks. Depending on the normality of data and data distribution, the comparison was done using Wilcoxon Signed Rank Test or dependent samples t-test. The level of significance was kept as p < 0.05. Results: Following six weeks of yoga sessions, a significant improvement in the high frequency power normalized unit (HFnu) and total power in comparison to baseline values was observed: 53.25� 10.14 versus 59.57 � 9.61 and 3238 � 1133 versus 3473 � 1130, respectively. Significant difference at six weeks between baseline and post yoga values was observed in TMT-A (30.16 � 5.04 vs 19.84 � 2.76) and TMT-B (69.96 � 12.99 vs 49.24 � 10.99). Sleep quality also improved significantly after yoga sessions (baseline PSQI score of 10.68 � 1.79 and post-PSQI score of 4.12 � 1.67). Conclusion: It was concluded that one hour of supervised yoga session every day for six weeks can improve HRV, sleep quality, and cognitive ability among medical students. Medical students should practice yoga regularly to improve cognitive function and sleep and to reduce cardiovascular morbidity.Item Recounting COVID-19 associated complement-mediated coagulopathies: Triggers and controls(National Academy of Medical Sciences, 2024-10) Lata, P; Madhuri, M; Ali, A; Kumari, B; Tiwari, M; Kumar, A; Hajela, K; Bhushan, D; Sharma, S.The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) led to a global health crisis, prompting extensive research into its pathogenesis and potential therapeutic interventions. One area of increasing interest is the interaction between SARS-CoV-2 and the complement system, a crucial component of innate immunity. This review explores the intricate relationship between COVID-19 and the complement system, shedding light on how the virus exploits and manipulates the complement components to induce inflammatory responses leading to coagulopathies. The activation of the complement pathway simultaneously activates the coagulation cascade due to the presence of common substrates of mannan-binding serine proteases of the lectin complement system in the coagulation pathway. This cross-talk between the components of the complement and coagulation system further aggravates the dysregulation of immune responses, contributing to the cytokine storm observed in severe COVID-19 cases. A comprehensive understanding of this crosstalk is crucial for developing targeted therapeutic strategies to mitigate the hyperinflammatory state associated with severe disease. Understandings into the molecular mechanisms governing this interaction may pave the way for the development of novel antiviral diagnostics and therapies based on immunomodulatory interventions, offering better management for such cases.