Guru Gobind Singh Medical College and Hospital

Children with epilepsy are particularly vulnerable to stigma, inadequate management, and exclusion from educational opportunities, especially in low-resource school environments. Despite the high prevalence of epilepsy, current school-based educational interventions are often fragmented and lack a structured, evidence-informed framework. This study aimed to develop a competency-based epilepsy education curriculum for school teachers to enhance seizure identification, appropriate response, and inclusive classroom support.

A mixed-methods, Delphi-guided study was conducted from February to July 2024 across five diverse Indian regions (urban and rural). Curriculum development followed Kern's six-step model, informed by Social Cognitive Theory and Adult Learning Principles. A comprehensive needs assessment identified core domains, including focus group discussions, stakeholder interviews, and literature review. A 42-member multidisciplinary expert panel participated in two Delphi rounds to refine content and learning objectives. Quantitative analysis (mean scores, per cent agreement, IQR) guided item consensus classification. Reflexive thematic analysis was applied to qualitative inputs.

A comprehensive competency-based epilepsy awareness curriculum for school teachers was developed. A needs assessment involving 60 participants across three centres identified eight thematic domains, including knowledge gaps, misconceptions, emergency response limitations, communication barriers, and resource constraints. This and the literature review informed the identification of 11 curriculum domains. Expert consensus through a two-round Delphi process (n = 42) finalised ten core domains and one introductory topic. An interdisciplinary panel formulated 58 competencies and 170 SMART learning objectives. The curriculum underwent preliminary field testing, and iterative refinements were made based on feedback from end users to enhance clarity, relevance, and applicability in school settings.

A telehealth-delivered, competency-based epilepsy curriculum was developed to address key knowledge and response gaps among school teachers. Informed by stakeholder input and expert consensus, it offers a scalable, evaluable model for improving school-based epilepsy care and may inform similar interventions for other chronic conditions.

Interleukin-6 (IL-6) is a pleiotropic cytokine that has an important function in the regulation of immunity, inflammation, hematopoiesis, and cancer biosynthesis. Liver cirrhosis is an advanced stage of liver fibrosis, and inflammatory cytokines play a key role in the activation of numerous cells involved in the pathogenesis of fibrosis.

The aims of this study were to assess serum IL-6 levels in patients with liver cirrhosis, and to study the correlation of IL-6 levels with the disease severity and mortality at 1 month in these patients.

This prospective observational study was conducted in the Medicine department of a tertiary care teaching hospital.

The study was conducted on 50 patients with liver cirrhosis aged 20–60 years. Serum IL-6 levels were measured by the chemiluminescence method in all the patients at the time of presentation. The relationships between IL-6 levels and the disease severity, in terms of Child-Turcotte-Pugh (CTP) score and class, and between IL-6 levels and mortality at 1 month, were analyzed.

The continuous variables were expressed as mean and standard deviation, whereas the categorical variables were summarized as frequencies and percentages (%). Non-normally distributed variables were expressed as the median and interquartile range (IQR). The Mann–Whitney U-test was employed for the comparison of two continuous variables and the Kruskal–Wallis test was employed for comparing 3 or more continuous variables. Spearman’s correlation coefficient (ρ) was employed to check the correlation between two continuous variables. Logistic regression analysis was used to identify independent predictors of disease outcome. P <0.05 was considered statistically significant.

Most patients were males (82%), and the maximum number of patients were in the age groups of 35–44 (32%) and 45–54 years (34%). Most of them had decompensated cirrhosis (CTP class B: 42% and CTP class C: 40%). On follow-up, 84% of patients were alive at 1 month, whereas 16% expired. Mean IL-6 levels of the study population were 38.39 ± 39.36 pg/mL. IL-6 levels showed a positive correlation with grade of ascites (P = 0.0001), grade of encephalopathy (P = 0.0001), CTP class (P = 0.0001), CTP score (ρ = 0.863), international normalized ratio (ρ = 0.356), serum bilirubin (ρ = 0.432), and a negative correlation with serum albumin (ρ = −0.344). IL-6 levels were significantly higher in patients who expired in comparison to those who were alive at 1 month (mean: 109.87 ± 45.57 pg/mL, median [IQR]: 120.13 [73.87–145.60] pg/mL vs. 24.77 ± 17.60 pg/mL, 22.55 [11.87–35.50] pg/mL, P = 0.0001). IL-6 was found to be a significant predictor of disease outcome (odds ratio = 1.084, 95% confidence interval = 0.99–1.19).

IL-6 levels were found to be significantly associated with the severity of liver cirrhosis. It also correlated with the disease outcome; higher levels were found in patients who expired during the follow-up period. Thus, IL-6 may be a reliable and independent predictor of disease severity and outcome in patients with liver cirrhosis.

Degenerative cervical myelopathy is a progressive neurological disorder resulting from extradural compression of the spinal cord at the cervical level. Clinically, it manifests with motor dysfunction, including hand clumsiness, gait instability, and signs of upper motor neuron involvement. In patients with multilevel cervical involvement, posterior decompressive laminectomy combined with lateral mass screw fixation is aimed at achieving effective spinal cord decompression while maintaining postoperative spinal stability.

This prospective case series aims to evaluate the clinical outcomes and quality of life following posterior decompression and lateral mass fusion in patients with multilevel compressive cervical myelopathy.

A total of 30 patients with compressive cervical myelopathy involving two or more levels were included in the study. Radiological assessments, including X-rays, MRI, and CT scans, were performed for evaluation. All patients underwent posterior cervical decompressive laminectomy combined with lateral mass fusion. Functional outcomes and quality of life were assessed preoperatively and at the one-year postoperative mark using the Japanese Orthopaedic Association (JOA) score and the Denis Pain and Work Scale as primary outcomes. Secondary outcomes assessed were perioperative complications, such as blood loss, neurological deterioration, infections, and implant failure.

The mean age of the patients was 49.5 years. Surgical intervention involved two-level decompression in nine patients (30%), three-level decompression in 14 patients (46%), and four-level decompression in seven patients (24%). The average blood loss was 202.6 mL, and the mean operative time was 135.3 minutes. At the one-year follow-up, the modified Japanese Orthopaedic Association (mJOA) score improved from a preoperative mean of 7.3 to 12.4. The Denis Pain Scale showed an improvement from 3.9 to 1.8, while the Denis Work Scale improved from 4.8 to 3.2. Postoperative complications included wound infections in two patients and transient neurological worsening in four patients, all of which resolved over time. There were no instances of implant failure.

Multilevel cervical laminectomy combined with lateral mass screw fixation is a reliable and effective surgical approach for the management of multilevel cervical myelopathy. This technique facilitates adequate spinal cord decompression, minimizes the risk of postoperative spinal deformities, and preserves the structural integrity of the posterior tension band.