The inaugural issue of the Asian Journal of Medical Sciences was published in May 2010. Full text articles available. AJMS is both online and printed journal. The electronic -ISSN is 2091-0576 and Print-ISSN is 2467-9100. AJMS was added to DOAJ on 26th May 2020. Last Updated 15th March 2025 AJMS was added to CAB Abstracts and/or Global Health database on 15th December 2020. Coverage will start from Volume 11, No. 1, 2020 onwards. Disclaimer- Asian Journal of Medical Sciences is solely responsible for any communication done from our official email IDs- ajmscience@gmail.com and editor@ajmsjournal.info If the authors receive any emails other than the above mentioned emails, we are NOT RESPONSIBLE for the same.
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Anesthetic management of cytoreductive surgery and hyperthermic intraperitoneal chemotherapy: A case series
Hyperthermic intraperitoneal chemotherapy (HIPEC) is a treatment for advanced abdominopelvic malignancies with peritoneal carcinomatosis. Cytoreductive surgery (CRS) with HIPEC offers hope by increasing the survival rates of these cancers. Anesthesiologists play an important role in HIPEC and cytoreductive procedures. This report presents five cases of advanced gynecological malignancies managed with CRS and HIPEC. All patients underwent the open coliseum technique. All patients scheduled for CRS+HIPEC were International Federation of Gynaecology and Obstetrics (FIGO) stage III or higher, confirmed by positron emission tomography-computed tomography, and staging laparotomy with intraoperative biopsies. Patients were preoperatively optimized based on age, physical status, and comorbidities. General anesthesia with thoracic epidural analgesia was administered. Physiological challenges during HIPEC, including fluid shifts, temperature fluctuations, and hemodynamic alterations, were effectively managed. None of the patients developed any major post-operative complications. They were extubated on the 1st post-operative day and discharged after 10–12 days. Understanding the physiological and pathological changes during CRS+HIPEC and individualized anesthesia management is essential for successful outcomes. Appropriate patient selection and vigilant monitoring minimize complications.
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Successful treatment of unresponsive bowenoid papulosis in female patients with intralesional measles, mumps, rubella vaccine: A case series
Bowenoid papulosis (BP) is a type of anogenital warts of benign proliferation caused by Human papillomavirus. Various therapeutic options available are topical imiquimod, podophyllotoxin, 5-fluorouracil, cryotherapy, radiofrequency, etc. However, few cases still remain unresponsive to ideal therapy. The current case series has not responded to the standard treatment modalities for which they were given intralesional immunotherapy using 0.5 mL of measles, mumps, and rubella (MMR) vaccine at a 3-week interval, and 90% to complete clearance was seen thereafter, and no reoccurrence even after follow-up of 5 months. Intralesional MMR vaccine can be used as immunotherapeutic modality in unresponsive BP as well as for the prevention of their reoccurrence.
Pediatric psoriasis: A case series of unusual presentation
Psoriasis is a chronic, immune-mediated skin disease affecting 0.5–2% of the global population, with a substantial proportion of cases manifesting in childhood. While plaque psoriasis predominates, pediatric presentations may include rare or atypical variants, often creating diagnostic and therapeutic challenges. Aim and Objective: To highlight the clinical spectrum and management of unusual pediatric psoriasis variants through a case series of infantile pustular psoriasis, genital psoriasis, and post-varicella guttate psoriasis.
Decoding cardio-kidney-metabolic disease networks: A proteogenomic roadmap to precision therapeutics
The emerging paradigm of cardio-kidney-metabolic (CKM) diseases as interconnected pathophysiological entities has been revolutionized by this comprehensive multi-omics investigation by Hirohama et al., which demonstrates that tissue-specific proteomics provides unique mechanistic insights beyond conventional genomic and transcriptomic approaches. By integrating whole-genome sequencing, RNA sequencing, and proteomics analysis of 337 human kidney samples with Bayesian co-localization and Mendelian randomization analyses across 36 CKM genome-wide association studies, this study identifies 89 prioritized proteins that illuminate previously unrecognized molecular bridges connecting cardiovascular, renal, and metabolic dysfunction. The discovery of kidney-specific roles for proteins such as angiopoietin-like protein 3 in lipid metabolism and renal function, alongside charged multivesicular body protein 1A in hypertension and kidney disease, exemplifies how tissue proteomics can unveil organ-specific contributions to systemic disease networks that are invisible to blood-based biomarker studies. This proteogenomic approach represents a critical methodological advancement in precision medicine, as it provides a systematic framework for identifying targetable therapeutic mechanisms by triangulating evidence from genetic susceptibility loci, tissue-specific gene expression patterns, and protein abundance levels—thereby offering a more complete molecular portrait of CKM disease interconnectivity that could inform the development of multi-target therapeutic strategies for the one-third of the global population affected by these devastating and economically burdensome conditions.
When rupture does not end the story, successful term birth after heterotopic pregnancy: A case report
Heterotopic pregnancy (HP) is the simultaneous coexistence of intrauterine and extrauterine gestations. It is rare, with an incidence of 1 in 30,000 in spontaneous conceptions, but up to 1 in 100 in assisted reproductive techniques. Diagnosis is often difficult in low-resource settings without high resolution ultrasonography. A 23-year-old primigravida, who conceived after two cycles of ovulation induction, presented at 6 weeks of gestation with worsening abdominal pain for 2 days. On admission, she was tachycardic, hemodynamically unstable, and in shock. Ultrasonography demonstrated a left adnexal mass, hemoperitoneum, and a viable intrauterine pregnancy (IUP) of 6–7 weeks. After arranging two units of cross-matched blood, an emergency laparotomy was performed. Intraoperative findings included a ruptured left ampullary ectopic pregnancy with approximately 900 mL of hemoperitoneum. The uterus was bulky and consistent with 6 weeks of gestation, while the right adnexa appeared normal. The patient had an uneventful postoperative recovery, and the IUP was monitored conservatively. At term, she underwent an emergency lower segment cesarean section and delivered a live female neonate weighing 3130 g, with Apgar scores of 7 and 9 at one and five minutes, respectively. HP, though rare, can follow ovulation induction. The presence of an IUP does not exclude a concomitant ectopic gestation. A high index of suspicion and timely diagnosis are crucial in women presenting with abdominal pain and an adnexal mass. Routine first-trimester ultrasound of the adnexa is essential for early detection.
Efficacy of quadratus lumborum block using injection bupivacaine as post-operative analgesia in patients undergoing nephrectomy: A randomized double-blind interventional study
Background: Nephrectomy is associated with significant post-operative pain, often managed with opioids that carry risks such as respiratory depression and nausea. Quadratus lumborum block (QLB), a regional anesthesia technique, has emerged as a promising alternative for pain relief by targeting both somatic and visceral nerves. However, limited evidence exists on its efficacy in nephrectomy patients, warranting further evaluation. Aims and Objectives: Nephrectomy is associated with significant post-operative pain, traditionally managed with opioids that pose risks of adverse effects. This study aimed to evaluate the analgesic efficacy and opioid-sparing effects of ultrasound-guided single-shot type 1 QLB using 0.25% bupivacaine. Materials and Methods: Sixty adult patients undergoing elective nephrectomy were randomized into two groups: Group A received 20 mL 0.25% bupivacaine and Group B received 20 mL 0.9% saline through type 1 QLB under ultrasound guidance. Standardized general anesthesia and post-operative intravenous patient-controlled analgesia with fentanyl were administered. Pain was assessed using the Numeric Rating Scale at multiple intervals up to 24 h. Observer’s Assessment of Alertness/Sedation (OAA/S) scores, opioid requirements, and adverse effects were recorded. Results: Fifty-eight patients completed the study. Group A showed significantly lower median pain scores at rest, on movement, and during coughing from 1 to 24 h post-extubation (P<0.001 at most time points). Cumulative fentanyl consumption at 24 h was markedly reduced in Group A (155±89 μg vs. 355±53 μg; P<0.001). Higher OAA/S scores were recorded in Group A, with no sedation or motor weakness. No block-related adverse events were noted. Minor complications, such as nausea and ileus, occurred only in Group B. Conclusion: A single-shot type 1 QLB using 0.25% bupivacaine significantly improves post-operative analgesia, reduces fentanyl consumption, and minimizes opioid-related side effects for 24 h following nephrectomy.
Continuous thoracic paravertebral analgesia versus continuous thoracic epidural analgesia in a case of mastectomy under general anesthesia for perioperative pain management- A prospective observational study
Background: Mastectomy is usually performed under general anesthesia (GA), but it is usually combined with different regional anesthesia techniques. Epidural and paravertebral blocks are both used for intraoperative and post-operative pain control. Aims and Objectives: The aim of this study was to compare the perioperative pain control, well-being of the patient, and recovery profile of patients who underwent mastectomy surgeries with two different modalities of anesthesia: Group A: GA with continuous thoracic paravertebral analgesia (TPVB), and Group B: GA with continuous thoracic epidural analgesia (TEA). Materials and Methods: In this prospective observational study, 64 consenting patients undergoing mastectomy requiring GA were selected who fulfilled the eligibility criteria and were assigned to either of the two groups alternatively: Group A – paravertebral block, or Group B – thoracic epidural block in a tertiary care hospital. Both the Group A and Group B patients were given 0.125% bupivacaine infusion at a rate of 5 mL/h for up to 48 h post-operative period by an infusion pump. Post-operative pain, the hemodynamic variables, and any adverse effects were assessed up to 48 h by a resident doctor. Results: Group A patients suffered minimal hemodynamic derangement intraoperatively. In the early post-operative period (early 24 h), Group A and Group B both had lower Visual Analog Scale scores and better pain control. Group A (9% pts) had required rescue analgesia in comparison to Group B, which did not require any rescue analgesia. Group A had a lower incidence of post-operative nausea and vomiting as compared to Group B. Conclusion: TPVB, though a difficult technique to learn, is a safe alternative to TEA in mastectomy surgery for its better hemodynamic control and longer post-operative analgesia, with minimal adverse events.
Efficacy of dexmedetomidine versus fentanyl in awake fiberoptic nasal intubation: A comparative study
Background: Awake fiberoptic nasal intubation (AFOI) is the preferred technique for securing difficult airways, but it requires optimal sedation and hemodynamic stability. Dexmedetomidine and fentanyl are commonly used agents, each with distinct pharmacologic profiles. Aims and Objectives: To compare the efficacy, safety, and impact of dexmedetomidine versus fentanyl on sedation, hemodynamic stability, and respiratory parameters during AFOI under general anesthesia. Materials and Methods: A randomized comparative study was conducted on 80 American Society of Anesthesiologists Grade I/II patients aged 20–40 years, undergoing AFOI for maxillofacial trauma and general surgery cases with restricted mouth opening. Patients were randomly divided into two groups: Group D received dexmedetomidine, and Group F received fentanyl. Parameters evaluated included intubation time, sedation scores, oxygen saturation levels, heart rate trends, cough scores, and side effects. Results: Group D showed significantly shorter intubation times, deeper and more stable sedation, fewer desaturation events, and better heart rate control than Group F. Dexmedetomidine was associated with manageable hypotension and bradycardia, whereas fentanyl had higher rates of hypoxia and respiratory distress. Conclusion: Dexmedetomidine proved superior to fentanyl in facilitating AFOI by offering better sedation, enhanced hemodynamic stability, and fewer respiratory complications, making it a preferred agent in difficult airway scenarios.
Study on relationship between serum electrolytes and pulmonary function tests in patients with chronic obstructive pulmonary disease in a tertiary care hospital, Kolkata
Background: Electrolyte imbalances during acute exacerbations of chronic obstructive pulmonary disease (AECOPD) can prolong hospitalization and influence disease outcomes. Aims and Objectives: The current study was conducted to determine the relationship between electrolyte levels and pulmonary function tests in patients with COPD. Materials and Methods: In this case–control study, a total of 140 patients were selected; among which 70 COPD patients were selected under case groups and 70 otherwise healthy participants were considered as controls. COPD patients were classified into 3 groups, mild, moderate, and severe as per Global Initiative for Chronic Obstructive Lung Disease criteria. The participants were assessed for pulmonary function tests and serum sodium, potassium, magnesium, calcium, and phosphate. Results: The mean serum sodium, potassium, and calcium levels were significantly lower (P<0.001) in patients with severe COPD as compared to mild-to-moderate COPD patients. Serum phosphate and magnesium concentrations were comparable in both groups. Hyponatremia (<135 mEQ/L) was the most common dyselectrolytemia. Serum sodium (r−0.671, P<0.001), potassium (r−0.489, P<0.001), and calcium (r−0.311, P=0.009) concentrations were shown to be significantly decreased in COPD cases and positively correlated with the percent forced expiratory volume in one second/forced vital capacity ratio. Conclusion: AECOPD patients with various electrolyte imbalances such as hyponatremia and hypokalemia require detailed treatment since they are at higher risk for complications.
Polycystic ovary syndrome and depression: A neurobiological and biochemical correlation
Background: Polycystic ovary syndrome (PCOS) is a complex endocrinological disorder that commonly affects women during their early reproductive years. The wide spectrum of symptoms and associated hormonal imbalances often results in significant psychological distress, leading to increased incidence of depression, anxiety, and other mood disorders. Aims and Objectives: This study aims to assess the severity of depression using the Montgomery–Asberg depression rating scale (MADRS) in women newly diagnosed with PCOS, and to evaluate its correlation with glucose metabolism, metabolic syndrome, and hormonal dysregulation. Materials and Methods: We conducted an observational cross-sectional study in which PCOS patients were stratified into mild, moderate, and severe depression categories based on their MADRS scores. Anthropometric, biochemical, and hormonal parameters were evaluated to identify the physical and clinical manifestations of PCOS. Results: Among the 69 PCOS patients studied, depression was classified as normal (n=38), mild (n=17), moderate (n=10), and severe (n=4) based on MADRS scores. The mean body mass index was elevated across all groups, indicating an overweight status (normal: 25.19±6, mild: 23.6±4.14, moderate: 24.8±4.1, and severe: 23.6±3.8). Insulin resistance (IR), as indicated by homeostasis model assessment–IR, was also elevated in all categories of patients with depressive disorder (normal: 2.86±1.8, mild: 2.3±0.72, moderate: 2.89±1.73, and severe: 2.45±0.84). The mean luteinizing hormone/follicle-stimulating hormone (LH/FSH) ratio was raised (normal: 2.55±1.62, mild: 1.35±0.67, moderate: 2.14±0.99, and severe: 2.4±1.6), and serum testosterone levels were elevated in all groups (normal: 1.24±0.83, mild: 0.97±0.76, moderate: 0.93±0.5, and severe: 1±0.63). Conclusion: Dysregulation of the hypothalamic–pituitary–ovarian and hypothalamic–pituitary–adrenal (HPA) axes plays a central role in the pathogenesis of both PCOS and associated depression. Clinical manifestations such as hirsutism, infertility, and altered LH/FSH ratios may hyperactivate the HPA axis, contributing to mood disorders. IR, acting synergistically with LH, leads to hyperandrogenemia and impaired glucose uptake in brain regions that regulate mood, potentially exacerbating depressive symptoms.
Patterns and prevalence of youth tobacco consumption in North-Eastern region: A global youth tobacco survey-based comparison with India
Background: Tobacco use among youth in India is a major public health concern, particularly in the North-Eastern region, where prevalence rates are higher than the national average. Understanding the patterns and determinants of youth tobacco consumption in this region is essential for developing targeted interventions. Aims and Objectives: To assess the prevalence and determinants of tobacco consumption among youth in North-Eastern India. Materials and Methods: This study utilized data from the Global Youth Tobacco Survey (GYTS), including the North-Eastern states. A comparative analysis was performed to estimate the prevalence of tobacco use (both smoking and smokeless) among school students aged ≤15 years in the North-Eastern region of India. Policy-related factors influencing tobacco consumption were also analyzed. Results: The GYTS-4 survey revealed significant regional disparities, with tobacco use higher in the North-East (P<0.05). Among current users, 44.06% attempted to quit in the past year (P=0.00028), and 47.15% wanted to quit immediately (P=0.0001). Youth exposure to tobacco smoke was high (55.71%, P=0.00006), though health awareness was stronger, with 45.83% noticing health warnings (P=0.001) and 80.76% observing anti-tobacco messages. Accessibility to tobacco products was also a concern, with 53.8% of cigarettes purchased from stores (P=0.0477). Conclusion: The North-Eastern region shows alarmingly high tobacco use, especially in Mizoram (89.7%) and Arunachal Pradesh (68.3%). However, there is a significant desire to quit, with states such as Manipur (61%) and Nagaland (65.7%) showing strong cessation efforts. The findings underline the urgent need for culturally sensitive tobacco control strategies in this high-risk region.
Mental health burden in adolescents: Identifying depression and anxiety using brief screening tools – A cross-sectional study
Background: Adolescence is a transitional stage characterized by significant biological, psychological, and social changes that may predispose individuals to mental health disorders. Depression and anxiety are among the most prevalent psychiatric conditions in this age group, contributing substantially to morbidity and impaired functioning. Despite their high prevalence, these disorders often remain under-recognized, particularly in low-resource settings where mental health infrastructure is limited. The use of validated, brief screening instruments may facilitate early detection and timely intervention. Aims and Objectives: The objective of this study was to determine the prevalence of depression and anxiety among adolescents in Eastern India and to explore their sociodemographic correlates using brief, validated screening tools. Materials and Methods: This cross-sectional, observational study was conducted between January and December 2023 at the Eastern Railway Hospital, Liluah, and an adjacent co-educational higher secondary school. A total of 107 adolescents aged 10–19 years were enrolled through convenience sampling. Depression was assessed using the patient health questionnaire-2 (PHQ-2), and anxiety was evaluated using the generalized anxiety disorder 7-item (GAD-7) scale. Sociodemographic data were collected using a structured pro forma. Statistical analysis included descriptive statistics and logistic regression to identify independent predictors. Results: Of the 107 participants, 30 (28.0%) screened positive for depressive symptoms (PHQ-2 ≥ 3), whereas 47 (43.9%) screened positive for anxiety symptoms (GAD-7 ≥ 5). Moderate-to-severe anxiety (GAD-7 ≥ 10) was observed in 29.9% of respondents. Depression was more frequent in males (29.4%) compared to females (25.6%) and in late adolescents (50.0%) compared to mid (34.6%) and early (25.0%) adolescents; however, these differences were not statistically significant. Multivariate logistic regression identified anxiety as the only independent predictor of depression (Adjusted odds ratio=7.34; 95% confidence interval: 3.68–14.64; P<0.001). No significant associations were observed with gender, socioeconomic status, family type, or parental education. Conclusion: This study demonstrates a considerable burden of depression and anxiety among adolescents in Eastern India, with notable comorbidity between the two conditions. The findings highlight the need to integrate brief, validated screening tools such as PHQ-2 and GAD-7 into adolescent health programs to facilitate early identification and intervention, particularly in resource-limited contexts.
A study on factors associated with hypertension among workers in the cement industry
Background: Hypertension is a significant global health issue, particularly in industrial environments where employees are perpetually subjected to occupational hazards. Aims and Objectives: The study aims to evaluate the correlation between various modifiable factors and hypertension among these workers. Materials and Methods: A cross-sectional study was performed among cement industry workers utilizing a pre-tested questionnaire that included socio-demographic variables, daily and weekly work duration, physical activity levels, awareness of health risks, dietary practices, water consumption, junk food intake, high-sodium diet, personal habits, sleep patterns, stress levels, and health-seeking behavior regarding hypertension. Results: The study involving 164 male cement industry workers aged 18–65 revealed that 39 (24%) of the participants had hypertension. There was a statistically significant correlation with modifiable risk factors, including tobacco use, stress, reduced sleep duration, lack of physical activity, and obesity. A substantial number of employees suffered from persistent hypertension-related symptoms, prompting some to seek medical attention. However, sticking to long-term treatment was challenging due to the work environment’s setup. Conclusion: This study underscores the high incidence of hypertension among cement industry workers, associated with stress, tobacco consumption, physical inactivity, and obesity. Making lifestyle changes can significantly reduce your risk of developing health problems related to high blood pressure.
Epidemiology of great imitator (syphilis) in pregnancy in a tertiary care hospital, Tamil Nadu
Background: Maternal syphilis remains a significant global public health concern due to its potential for vertical transmission, leading to serious adverse fetal outcomes. If left undiagnosed or untreated, it can result in stillbirth, low birth weight, premature birth, congenital syphilis, and neonatal mortality. Despite the availability of effective and affordable treatment with benzathine penicillin, missed opportunities for screening and treatment during pregnancy continue to contribute to preventable morbidity and mortality. Aim and Objectives: The objectives of this study were as follows: (1) To evaluate the epidemiological characteristics of antenatal women diagnosed with syphilis. (2) To analyze the influence of treatment timing on pregnancy outcomes. Materials and Methods: A descriptive study was conducted at a tertiary care hospital in Tamil Nadu from August 2018 to April 2024. Data were retrospectively collected from RTI/sexually transmitted infection (STI) clinic records. The sample size was 14,396 out of which antenatal cases were 2880 patients. All antenatal women who tested positive for both Treponema pallidum hemagglutination assay and rapid plasma reagin (RPR) were included. Details of maternal treatment and subsequent neonatal outcomes, including RPR titers and clinical features, were evaluated to assess the impact of early treatment. Results: Out of 14,396 new clients who attended the STI clinic during the study period, out of which 2880 (20%) are ANC cases. Three hundred and forty (2.3%) were found to be RPR reactive. Among these, 48 (14%) were antenatal women. Of these 48 pregnant women, 44 had live births, one had preterm live birth, two had preterm neonatal deaths, and one induced abortion due to congenital anomaly. The majority received timely treatment, and early intervention was associated with improved fetal outcomes. Conclusion: Early antenatal screening and prompt treatment of maternal syphilis are critical in preventing adverse fetal outcomes and eliminating congenital syphilis.
Clinico-mycological aspects of dermatophytes against tinea infection from patient attending tertiary care hospital: A study from Himalayan region, Uttarakhand
Background: Superficial fungal skin infections are quite common and affect millions of people in the world over. Dermatophytes are the most common causative agents of these superficial fungal infections. There has been an increasing trend and changing pattern of dermatophytosis, in Garhwal region, Uttarakhand. Aims and Objectives: This study was aimed to identify the clinical and mycological profile of dermatophytes infection from clinical sample in Uttarakhand, India. Materials and Methods: Dermatophytes suspected samples from patients were examined according to standard mycological protocols such as potassium hydroxide mount and Sabouraud’s dextrose agar (SDA) culture. Causative organisms were identified by macroscopic and microscopic examination after growth on SDA (with or without cycloheximide and chloramphenicol) and confirmed by lactophenol cotton blue mount, slide culture technique, and biochemical test. Results: Out of 652 clinical samples, 96 (14.7%) samples showed positive fungal culture. Among these 96 positive fungal cultures, 65 (67.7%) were dermatophytes (predominantly isolates were Trichophyton mentagrophytes) and 31 (32.3%) were non-dermatophytes (including Aspergillus spp., Candida albicans and Non-albicans Candida species. Male predominance was found among the patients being 1.5:1 (male: female) ratio. Conclusion: Among the dermatophytic infections, T. mentagrophytes was found to be predominant isolate in Garhwal region, Uttarakhand.
Comparison of serum-ascites albumin gradient and platelet count/splenic diameter ratio in predicting esophageal varices in cirrhosis of liver
Background: Prediction of esophageal varices (EV) in cirrhotic patients by non-invasive methods is of greatest importance as it may decrease medical and economic load related to screening. In this study, we aim to validate and compare the platelet count/spleen diameter ratio (PC/SD) and serum-ascites albumin gradient (SAAG) as predictors of EV in patients with cirrhosis of liver. Aims and Objectives: The study was conducted to determine, assess, and compare the efficacy of SAAG and PC/SD in predicting EV in patients with cirrhosis. Materials and Methods: The study was conducted on eighty patients with cirrhosis of liver at Kempegowda Institute of Medical Sciences, Department of General medicine, Bangalore, over a period of 2 years. All relevant clinical parameters including examination, laboratory tests, endoscopy, spleen measurement, and ascitic fluid analysis were done and documented. Results: The study predominantly included male patient’s (90%) with mean age 48.84±10.92 years. EV present in 87.5% of patient’s, with 97.5% having high SAAG (>1.1). SAAG significantly correlated with variceal presence (P<0.001), while PC/SD showed no correlation (P=0.593). Conclusion: Elevated SAAG showed statistically significant correlation with EV in cirrhotic patient’s and served as a better predictor in liver cirrhosis, while PC/SD showed no correlation. Therefore, SAAG is a better predictor for the presence of EV compared to PC/SD.
Prediction of gestational diabetes mellitus in antenatal women based on fetal epicardial fat thickness, maternal abdominal subcutaneous fat thickness, and placental thickness
Background: Gestational diabetes mellitus (GDM) is a common pregnancy complication associated with maternal obesity, placental thickness, and adverse perinatal outcomes, including pre-eclampsia and fetal metabolic disorders. Aims and Objectives: This study aimed to determine whether variations in fetal epicardial fat thickness, maternal abdominal subcutaneous fat thickness (ASFT), and placental thickness are associated with the risk of GDM and adverse outcomes. Materials and Methods: This prospective cross-sectional study included 139 patients treated at the Barnard Institute of Radiology, MMC, and RGGGH between May 2021 and October 2022. Fetal epicardial fat, placental thickness, and ASFT were measured via ultrasound and compared with oral glucose tolerance test results at 20–22 weeks to predict GDM. GDM cases were followed up until term to assess delivery mode, neonatal outcomes, and complications. Results: Correlations were observed between Random Blood sugar, placental thickness, abdominal subcutaneous thickness, and epicardial fat thickness in pregnant women with and without GDM. GDM was present in 20.1% of 139 patients. Significant positive correlations were observed between the RBS and placental thickness (r=0.316, P=0.0002) and between the RBS and epicardial fat thickness (r=0.552, P=0.0005). Placental thickness differed significantly in GDM patients (2.91±0.66 mm) compared to non-GDM (2.35±0.64 mm; P=0.0001). Abdominal subcutaneous and epicardial fat thicknesses were also significantly higher in GDM patients (P=0.011 and P=0.0005, respectively). Conclusion: The combination of Epicardial Fat Thickness, Abdominal Subcutaneous Fat Thickness and Placental Thickness is a predictive factor for GDM during the early second trimester, with EFT being the most significant. Early prediction and intervention for GDM using these parameters may help reduce maternal and fetal complications.
Assessment of functional recovery in boxer’s fractures treated by bouquet technique and casting
Background: Fracture neck of the fifth metacarpal, also known as boxer’s fracture, is the most common metacarpal fracture, accounting for ~36% of cases. Treatment options vary from conservative immobilization to surgical fixation, but there is no clear consensus on the optimal approach. Aims and Objectives: To compare the functional outcomes of boxer’s fractures treated with antegrade intramedullary bouquet K-wire fixation versus cast immobilization. Materials and Methods: This prospective study was conducted at the Department of Orthopaedics, Chettinad Hospital and Research Institute, Kancheepuram, after approval by the Institutional Ethics Committee (Approval No: IHEC-1/2475/2). Thirty patients with a fracture neck of the fifth metacarpal were included and randomized into two groups: Group A (bouquet fixation, n=15) and Group B (cast immobilization, n=15). Patients were followed up for 6 months. Outcomes were assessed clinically and radiologically using grip strength, neck-shaft angle, QuickDASH score, and Visual Analog Scale (VAS) pain score. Results: At 6 months, Group A showed superior outcomes compared to Group B: mean grip strength (107.5±9.4 vs. 82.3±19.3, P<0.001), neck-shaft angle (20.5°±2.5 vs. 24.3°±3.5, P<0.001), QuickDASH score (4.8±2.4 vs.10.2±3.1, P<0.001), and lower VAS scores (P=0.002). All fractures united radiologically within 12 weeks. Complications in Group A included pin tract infection (1 case) and K-wire migration (1 case), while malunion and hand stiffness were more frequent in Group B. Conclusion: Antegrade bouquet K-wire fixation provides better functional and radiological outcomes with fewer complications compared to cast immobilization in boxer’s fractures. It is a minimally invasive, effective technique with a short learning curve and should be considered as a preferred option in young active patients.
Association of maternal serum levels of n-terminal pro-brain natriuretic peptide with increasing severity of pre-eclampsia
Background: Hypertensive disorders in pregnancy account for 14% of global maternal mortality and are globally the second most common cause of maternal morbidity. Among the hypertensive disorders of pregnancy, pre-eclampsia and eclampsia lead to the most deaths. Pre-eclampsia can deteriorate quickly and affect multiple organ systems. Various biomarkers are increased in pre-eclamptic women, including N-terminal prohormone of brain natriuretic peptide (NT-proBNP). Hence, we studied the association of maternal serum levels of NT-proBNP with pre-eclampsia. Aims and Objectives: To determine serum levels of NT-proBNP in patients with pre-eclampsia and to see the association of increased levels of NT-proBNP with the severity of pre-eclampsia. Materials and Methods: A prospective observational study was conducted on 88 hypertensive pregnant women presenting to the gynecology outpatient department of PBM hospital, Bikaner. They were divided into two groups: group A consisting of 44 pregnant women with pre-eclampsia without severe features, and group B consisting of 44 pregnant women with pre-eclampsia with severe features. After getting proper written consent, 5 mL of fasting venous sample was collected at term or just before induction of labor or in early labor in both groups. Results: Significantly elevated serum levels of NT-proBNP were seen in group B (pre-eclampsia with severe features) (mean systolic blood pressure [SBP]: 167.44±9.33, diastolic blood pressure [DBP]: 105.53±7.63) than in group A (pre-eclampsia without severe features) (mean SBP: 148.47±4.85, DBP: 98.36±4.88). The value of NT-proBNP was 489.2±259.2 in group B and 169.52±51.98 in group A (P<0.001). Thus, there is a significant association of NT-proBNP with increasing severity of pre-eclampsia. Conclusion: NT-proBNP is a useful marker to predict the severity of pre-eclampsia. Higher levels of NT-proBNP are seen in more severe grades of pre-eclampsia.
A study of the prevalence of gestational thrombocytopenia and complications in Virudhunagar locality
Background: Thrombocytopenia, the second most common hematological abnormality in pregnancy after anemia, ranges from benign gestational changes to serious pathological disorders. Aims and Objectives: This study aimed to evaluate its prevalence, underlying causes, and associated maternal complications among antenatal women at a tertiary care center. Materials and Methods: This prospective observational study was conducted over 6 months at a tertiary care center, enrolling 50 antenatal women with a platelet count <150,000/mm3 in any trimester. Detailed clinical history, examination, and laboratory investigations were performed to determine the cause of thrombocytopenia and its associated complications. Results: Multiparous women were the majority of the patients (70%), followed by primigravida (24%) and grand multiparous (6%) women. Most patients were diagnosed in the third trimester, and mild thrombocytopenia was the most common severity pattern observed. Gestational thrombocytopenia (GT) was the predominant cause (66%), followed by thrombocytopenia associated with hypertension (18%), immune thrombocytopenia (10%), viral infections (4%), and idiopathic causes (2%). Maternal complications were more frequent in hypertensive-related thrombocytopenia and included antepartum hemorrhage, postpartum hemorrhage, hemolysis, elevated liver enzymes, and low platelets syndrome, disseminated intravascular coagulation, shock, and wound infections, with a single patient in each. GT is generally mild, with few complications. Conclusion: GT was the leading cause of thrombocytopenia in pregnancy, occurring more frequently in multiparous women and during the third trimester, and was typically associated with minimal adverse outcomes. Pathological causes, particularly hypertensive disorders, are associated with a higher risk of adverse maternal events. Routine platelet count monitoring and early etiological evaluation are essential for timely diagnosis, targeted management, and improved maternal and fetal outcomes
Prevalence of Vitamin D3 deficiency in patients undergoing elective neurosurgical procedures and its effects on morbidity and mortality
Background: Vitamin D3 plays a crucial role in calcium homeostasis, bone metabolism, muscle strength, and immune modulation. Its deficiency has been linked to increased postoperative complications, impaired wound healing, and higher mortality risk. However, data on Vitamin D3 status among neurosurgical patients remain limited. Aims and Objectives: The aim of the study was to determine the prevalence of Vitamin D3 deficiency in patients undergoing elective neurosurgical procedures and evaluate its association with post-operative morbidity and mortality. Materials and Methods: In this hospital-based prospective observational study 170 adult patients who were admitted for elective neurosurgical procedures during the study period were enrolled. Blood samples were collected within 48 h of admission and Vitamin D3 levels were measured using a chemiluminescence immunoassay in the central biochemistry laboratory at Sher-i-Kashmir Institute of Medical Sciences. The primary outcomes assessed were the prevalence of Vitamin D3 deficiency in the study population and its association with post-operative morbidity and mortality. Secondary outcomes included length of hospital stay, requirement of intensive care unit care, and readmission rates. Results: Vitamin D3 deficiency was observed in 54 patients (31.8%), while 46 patients (27.1%) had insufficient levels. Multivariate logistic regression analysis identified Vitamin D3 deficiency as an independent predictor of prolonged hospital stay, with an adjusted odds ratio of 2.15 (95% confidence interval: 1.12–4.21, P=0.02). Conclusion: Vitamin D3 deficiency is highly prevalent among elective neurosurgical patients and is independently associated with increased hospital stay. Pre-operative screening and correction may be a simple, cost-effective strategy to improve surgical outcomes.
Examining the association of menarche and correlates in a rural polycystic ovary syndrome population: A cross-sectional study
Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder with larger metabolic and reproductive implications. Age at menarche is a potential marker for PCOS risk and linked to hyperandrogenism; seemingly relationship with clinical, hormonal, and metabolic features remains complicated and under-researched in rural populations. Aims and Objectives: Our study aimed to examine the relationship of age at menarche and the clinical, hormonal, and metabolic features of PCOS patients in the rural population. The objectives were to divide participants by menarche age, compare their clinical, hormonal, and biochemical profiles, and assess their relationship with age at menarche. Materials and Methods: This study was cross-sectional in nature, conducted at a rural tertiary care hospital from January to June 2025. Sixty-eight women diagnosed with PCOS by Rotterdam criteria were enrolled. Participants were classified into early (<11 years), normal (12-14 years), and late (>15 years) menarche groups. Sociodemographic variables, clinical features, and hormonal assays were collected and analyzed using SPSS. Results: The Mean age of our participants was ~23 years, predominantly from rural backgrounds. No significant variations were found in baseline characteristics, hormonal levels (Testosterone, Anti-Müllerian Hormone, Luteinizing Hormone: Follicle-Stimulating Hormone ratio), or metabolic markers through menarche groups, as all were P>0.05. The early menarche group had a significantly higher Ferriman-Gallwey score (10.6±4.7, P=0.038). Correlation analysis had a significant, but weak, negative association between menarche age and hirsutism (r = −0.22, P=0.044). Conclusion: In this rural population of PCOS patients, age at menarche was not related to significant variations in baseline hormonal or metabolic profile. Early menarche was linked to hirsutism, paving the way for it may serve as a simple, non-invasive clinical indicator for identifying PCOS patients at higher risk for hyperandrogenism.
A clinical study on patients undergoing extended cholecystectomy for gall bladder cancer with special emphasis on short-term outcome
Background: Gall bladder cancer (GBC) is an aggressive disease often presenting at an advanced stage. It is the most common hepatobiliary malignancy in eastern India. Extended cholecystectomy (EC), the currently accepted definitive surgery for GBC, being a major surgical procedure, has considerable morbidity and mortality. Aims and Objectives: This study aims to study the profile of patients undergoing EC and evaluate the peri-operative events and post-operative outcome. Materials and Methods: It was conducted over 1.5 years. 30 patients undergoing EC for radiologically-suspicious/peri-operative findings suggestive of GBC were considered as per the inclusion and exclusion criteria. Results: Of the 30 patients studied, 24 (80%) were >50 years age, 20 (66.7%) were female, 27 (90%) were non-vegetarian, 26 (86.7%) had pain abdomen, and 7 (23.3%) had pallor. No patient had a lump abdomen, jaundice, icterus, or clinically detectable lymphadenopathy. On ultrasonography (USG), 22 (73.3%) had intraluminal mass, 25 (83.3%) had gallstones; on computed tomography scan, 24 (80%) had intraluminal mass, 17 (56.7%) had no adjacent structure invasion, and 11 (36.7%) had liver bed invasion. None required resection of the extrahepatic biliary tree. Post-operatively, 7 (23.3%) required intensive care, 1 (3.3%) had a hematoma, 6 (20%) had surgical site infection, and 4 (13.3%) had bile leak. Histopathology showed adenocarcinoma gall bladder in 25 (83.3%) and papillary carcinoma in 1 (3.3%). Post-surgery USG at 1 month was normal in 25 (83.3%) patients, and 4 (13.7%) had mild collection in the Hepatorenal Pouch of Morrison. All had a normal USG report at 3 months post-surgery. Conclusion: GBC is more common in females aged 51–60 years. Pain abdomen is the most common symptom. Post-operative intensive care is not required for majority of the patients undergoing EC. Most complications can be managed conservatively.
Interferon-gamma and nitric oxide burst response in different categories of pulmonary tuberculosis patients
Background: Anti-tuberculous cellular immunity involves the critical interplay of T lymphocytes, macrophages, and cytokines. The quantitative analysis of pro-inflammatory cytokine (interferon-gamma [IFN-γ]) release and nitric oxide (NO) production by in vitro challenged macrophages from tuberculosis (TB) patients of different clinical settings and healthy controls would enlighten our knowledge of macrophage efficiency at different age and status of disease, thereby paving the way for immunotherapy. Aims and Objectives: To study the pattern of release of IFN-γ and NO burst response by macrophages, from pulmonary TB cases compared to normal individuals, in vitro culture, on challenge with Bacillus Calmette-Guérin (BCG) and Mycobacterium tuberculosis H37Rv. Materials and Methods: Fifteen consecutive sputum smear-positive newly diagnosed TB and 15 relapsed TB cases were recruited. All cases were pulmonary with no BCG vaccination history. 15 tuberculin skin test (TST) positive, 15 TST negative healthy volunteer, and 5 newborn antigen naïve cases were included as control. Isolated macrophages were cultured and pretreated with BCG and H37Rv. IFN-γ and NO were measured from the cell free culture supernatant after 24 h. Results: The monocytes of the patients are functionally different than the healthy subjects toward the same antigenic stimulation. The level of NO release correlates with the extent of IFN-γ production. The presence of Th1 response and associated factors like NO burst are some of the main regulators of the outcome of the disease. Conclusion: Capacity to mount inflammatory response, effective NO generation determines the outcome of TB infection and may contribute to better understanding of the underlying immunopathology.
Sensitivity of ultrasound in detecting posterior segment pathology in mature cataract patients: A prospective observational study
Background: Ocular B-mode ultrasonography (USG) acts as a valuable adjuvant for assessing the posterior segment of the eye in mature cataract, especially when fundus visualization is obscured by media opacities such as vitreous hemorrhage, asteroid hyalosis, and tumors. Aims and Objectives: To study the accuracy of ultrasound to evaluate posterior segment pathologies in mature cataract patients, which would help in planning surgical intervention, and to assess post-operative visual prognosis. Materials and Methods: This is a prospective observational study among 112 patients who visited the ophthalmology outpatient department of SRM Medical College, Hospital, and Research Centre with mature cataract whose fundus could not be visualized and who fit the inclusion and exclusion criteria. Detailed history, ophthalmic examination, and pre-operative B-Scan Ultrasound Examination were done. Pre-operative ultrasound findings were compared with post-operative fundus examination to assess the sensitivity of ultrasound in detecting posterior segment pathology. Results: Asteroid hyalosis, choroidal coloboma, inferior retinal detachment, posterior staphyloma, posterior vitreous detachment, vitreous hemorrhage, and vitreous opacity were diagnosed equally both in pre-operative B scan findings and in post-operative fundus findings. The pre-operative B scan findings had a sensitivity of 59.62%, specificity of 95.59%, positive predictive value of 91.18%, negative predictive value of 75.58%, and diagnostic accuracy of 80%. Conclusion: Pre-operative B scan USG is an effective diagnostic tool for evaluating posterior segment pathology in mature cataract, allowing better surgical planning and prognosis assessment. Its accuracy can be further improved when correlated with clinical findings and tailored to specific clinical conditions.
Fine-needle aspiration cytology as a screening tool for palpable breast lesions: Comparative analysis with histopathology
Background: Breast cancer remains a leading malignancy among women worldwide, underscoring the need for timely and accurate pre-operative evaluation of breast lumps. In resource-limited settings, diagnostic challenges persist due to limited access to advanced modalities. Despite the growing preference for core needle biopsy, fine needle aspiration cytology (FNAC) continues to serve as a vital diagnostic tool due to its simplicity, affordability, and rapid turnaround. Aims and Objectives: The present study evaluates the diagnostic utility of FNAC in palpable breast lesions and correlates cytomorphologic findings with histopathological outcomes, to assess its sensitivity, specificity, and overall diagnostic accuracy. Materials and Methods: The study was conducted over 21 months (September 2019–June 2021) at the Department of Pathology, Shimoga Institute of Medical Sciences, Shivamogga, which included 100 patients with palpable breast lumps. FNAC was performed following clinical evaluation, and aspirates were categorized using National Health Service Breast Screening Program (NHSBSP) criteria (C1–C5). Histopathological confirmation was obtained post-surgical excision. Results: Of the 100 FNAC cases, distribution by NHSBSP criteria was as follows: C1–2, C2–63, C3–7, C4–3, and C5–25. Benign lesions (C2) predominated, with fibroadenoma as the most common diagnosis (n=46). Among malignant cases (C5), infiltrating ductal carcinoma was the leading type (n=24). All cases were histologically confirmed. FNAC showed excellent diagnostic performance with sensitivity 100%, positive predictive value 95.24%, negative predictive value 100%, and overall accuracy 96.59%. Conclusion: FNAC remains a highly accurate, minimally invasive, and cost effective modality for evaluating palpable breast lesions. Its diagnostic reliability reinforces its role in both benign and malignant pathology, especially in settings with limited resources.
Study to evaluate mesenteric lymph node on ultrasound and its association with clinical symptoms in pediatric population
Background: Abdominal pain is a frequent complaint in children, often leading to diagnostic uncertainty due to its non-specific presentation and varied etiology. Mesenteric lymphadenopathy is a common yet ambiguous ultrasound finding in such cases. While often benign and reactive, it can also signify infections, inflammatory diseases, or malignancies. Ultrasonography (USG) serves as a first-line modality due to its safety, accessibility, and diagnostic yield in evaluating pediatric abdominal pathology. Aims and Objective: The aim of the study was to assess the diagnostic value of USG in detecting enlarged mesenteric lymph nodes (MLNs) and to correlate sonographic findings with clinical symptoms in the pediatric population. Materials and Methods: This observational cross-sectional study included 180 pediatric patients (aged neonate to 18 years) presenting with abdominal symptoms at a tertiary care center between February 2020 and September 2021. All subjects underwent grayscale and color Doppler USG. Lymph node characteristics – size, shape, vascularity, echogenicity, and associated abdominal findings – were recorded and analyzed using the Statistical Package for the Social Sciences v21. Results: Significantly enlarged MLNs (Short-axis diameter [SAD] ≥5 mm) was found in 100 (55.5%) patients, predominantly in males (72%). Most nodes were located in the right iliac fossa and periumbilical regions. Among them, 60% showed no other abnormal USG findings. However, 40% had additional ultrasound features suggesting specific etiologies, including reactive adenitis (23%), tubercular adenitis (8%), lymphoma (1%), and metastasis (1%). Statistical correlation revealed a significant association between lymph node size and the presence of clinical symptoms (P<0.05). Nodes with absent hilum, heterogeneous echotexture, and high resistivity index were more likely to represent pathological conditions. Conclusion: Ultrasound is a valuable non-invasive tool for evaluating mesenteric lymphadenopathy in symptomatic children. A SAD ≥5 mm is a useful threshold. Correlation with clinical findings enhances diagnostic accuracy, aids in avoiding unnecessary interventions, and facilitates early identification of serious underlying conditions.
A clinical study on the diagnostic significance of sepsis markers in neonatal sepsis in a tertiary care center
Background: Sepsis is a major cause of mortality in neonates after prematurity. Timely diagnosis using sepsis markers is crucial for management, especially where blood culture confirmation may be delayed or unavailable. Aims and Objectives: The aims and objectives of the study are to identify the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of sepsis markers in a neonate with sepsis. Materials and Methods: A hospital-based observational study was conducted from May 2023 to November 2024. 100 neonates (<28 days old) with clinical features or risk factors suggestive of sepsis presenting to the Neonatal Intensive Care Unit were included. Exclusion criteria were birth asphyxia, birth weight <1,500 g, gestational age <32 weeks, or prior antibiotic use. Data collection included clinical assessments and laboratory measurements of total leukocyte count (TLC), platelet count (PLT), C-reactive protein (CRP), and blood cultures. Statistical analysis was performed using the Statistical Package for the Social Sciences version 25. Results: One hundred neonates (63 males and 37 females) were enrolled. TLC was abnormal in 32% of cases, thrombocytopenia in 44%, and raised CRP in 89%. Blood culture-confirmed sepsis was found in 18%, probable sepsis in 29%, and suspected sepsis in 53%. TLC sensitivity was 33.3% and specificity was 24.4%, PPV was 8.8% and NPV was 62.5%. PLT sensitivity was 72.2% and specificity was 62.2%. Males and low birth weight/preterm neonates were most affected. Conclusion: Combined use of TLC, PLT, and CRP is necessary for screening neonatal sepsis, enabling early intervention and better outcomes.
The association between serum ferritin and febrile seizure in children
Background: Between the ages of 6 and 60 months, febrile seizures can happen when a child’s temperature is 38°C or higher, there is no infection in the central nervous system, and there is no metabolic imbalance. These seizures can happen in 2–5% of neurologically healthy infants and children. Iron deficiency has been postulated to reduce neurotransmitter function, thereby decreasing seizure threshold in children. Most studies conclude that iron deficiency anemia is common in febrile seizure patients, although some have found no significant association. Aims and Objectives: Investigate the association between serum ferritin levels and the occurrence of febrile seizures in children aged 6–60 months. Materials and Methods: The study population included 180 patients, 90 of whom had febrile seizures, and 90 controls without seizures. Hematological parameters, including complete blood count, mean corpuscular volume, mean hemoglobin concentration, red cell distribution width, serum iron, plasma ferritin, and total iron binding capacity, were performed, along with a peripheral smear. Statistical analysis of laboratory results was performed using the Statistical Package for the Social Sciences version 24. Significance levels were denoted as P≤0.05. Results: Simple febrile seizures were the most common type in children. The serum ferritin levels were significantly lower in cases compared to controls (41.13±22.12 vs. 70.06±36.47 ng), P=0.0003. Children with febrile seizures had a higher proportion of microcytic hypochromic anemia (39/90), in contrast to controls (25/90); P=0.029. Conclusion: Plasma ferritin levels were significantly lower in cases compared to controls, suggesting that iron-deficient children are more prone to febrile seizures. Hence, children with febrile seizures should be investigated and treated for iron deficiency anemia.
Assessing local control, toxicity with hippocampal avoidance whole-brain radiotherapy with a simultaneous integrated boost for single and limited brain metastases
Background: Although whole-brain radiotherapy (WBRT) has been the standard treatment for brain metastases, its cognitive side effects have led to the rise of stereotactic radiosurgery (SRS), which offers better local control with less neurocognitive decline. Aims and Objectives: This study aimed to determine toxicity using common terminology criteria for adverse events (CTCAE) grading and assess local control at the metastatic site and distant intracranial control using the response assessment in neuro-oncology (RANO) criteria for hippocampal avoidance WBRT (HA-WBRT) with a simultaneous integrated boost (SIB). Materials and Methods: This cross-sectional study included 22 patients from Tirunelveli Medical College between February 2022 and June 2024. Data were collected through direct patient interviews, and baseline quality of life (QoL) was assessed using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life questionnaire (QLQ)-C15-PAL. Each patient underwent a planning computed tomography (CT) scan with thermoplastic mask immobilization. Gadolinium-enhanced T1-weighted magnetic resonance imaging (MRI) was co-registered with CT to delineate target volumes and organs at risk. The hippocampus was contoured per standard guidelines. The planning target volume for WBRT (PTV-WBRT) included the whole brain with a 3 mm margin, excluding the PTV-metastases and HA region. Toxicity (CTCAE) and QoL (EORTC) were evaluated at 3 months, and local tumor control was assessed at 6 months using RANO criteria and MRI assay. Results: Local tumor control was achieved in 77.27% of cases. Local control was not significantly associated with age, gender, primary tumor site, or number of metastases, but was significantly lower in patients with associated extracranial metastases (P=0.0005). Patients with local control had significantly better QoL scores at baseline, 3-, and 6-month post-treatment (P<0.05). Radiologic tumor response assessed by RANO criteria at 6 months showed a strong correlation with local control (P=0.0005). Similarly, higher toxicity grades were significantly associated with a lack of local control at both 3 and 6 months (P=0.0002 and P=0.002, respectively). Conclusion: HA-WBRT with a SIB achieved effective local tumor control and improved intracranial progression-free survival in patients with single and limited brain metastases. This approach showed minimal toxicity and was associated with significantly better QoL outcomes.
A comparative study to assess local control and toxicity in patients with high-risk head and neck squamous cell carcinoma treated with post-operative adjuvant concurrent chemoradiotherapy using cisplatin versus docetaxel and cetuximab
Background: Patients with locally advanced head and neck cancer, specifically those with high-risk features like margin-positive resection or extracapsular nodal extension, have high recurrence rate following surgery alone. There are limited data available in the literature on adjuvant chemoradiation with weekly cisplatin versus docetaxel and cetuximab in patients with post-operative high-risk head and neck squamous cell carcinoma (HNSCC) in Eastern India. Aims and Objectives: The Objectives of this study were to compare loco-regional disease control, toxicities, progression-free survival, and distant metastasis-free survival (DMFS) between adjuvant chemoradiation with weekly cisplatin versus docetaxel and cetuximab in post-operative-high-risk HNSCC. Materials and Methods: About 30 patients in ARM-1 received weekly cisplatin with concurrent radiotherapy, and 30 patients in ARM-2 received weekly docetaxel and cetuximab with concurrent radiotherapy. Radiation dose was 66 Gy in 33 fractions in each arm. Results: In ARM-1, 19 (63.3%) patients had grade 2, and 6 (20.0%) patients had grade 3 mucositis. In ARM-2, 10 (33.3%) patients had grade 2, and 19 (63.3%) patients had grade 3 mucositis. In ARM-1, 3 (10.0%) and ARM-2, 18 (60.0%) patients had a rash. In ARM-1, 2 (16.7%) and ARM-2, 1 (5.3%) patients had metastasis, and in ARM-1, 10 (83.3%) and ARM-2, 18 (94.7%) patients had achieved DMFS of 15 months. Conclusion: Loco-regional failure-free survival at 12th months shows statistical significance in favor of ARM-2. Cetuximab plus docetaxel may be established as a treatment option as concurrent chemotherapy with radiation at the adjuvant setting in head and neck carcinoma, especially in situations where cisplatin is contraindicated or difficult to administer.
A prospective comparative randomized study to asses local control and toxicity in patients with intermediate risk oral cavity squamous cell carcinoma with post-operative adjuvant radiotherapy with or without cetuximab
Background: Treatment of oral cavity cancer includes surgery, radiotherapy (RT), chemotherapy, and immunotherapy. Surgery followed by adjuvant RT plays an important role in patients with intermediate risk factors but many studies showed locoregional failure following adjuvant RT alone. Elevated epidermal growth factor receptor (EGFR) expression is detected in 90% of patients with head and neck squamous cell carcinoma (SCC). Aims and Objectives: The objective of this study was locoregional disease control, toxicities, disease-free survival (DFS), and OS between post-operative only RT and concurrent cetuximab (CP) with RT in oral cavity SCC with intermediate risk factors. Materials and Methods: Arm A received adjuvant RT at a dose of 60 Gy by 30 fractions, total 6 weeks duration. In study arm B received the same dose of adjuvant RT as study arm A along with concomitant injection of cetuximab at a dose of 400 mg/m2 prior to start of RT and then 250 mg/m2 weekly. Results: In arm A, 14 (56.0%) and arm B, 14 (56.0%) patients had anterior 2/3rd of tongue and buccal mucosa cancer, respectively. In arm A, 15 (60.0%) and arm B, 12 (48.0%) patients had pT2 status, respectively. There was no rash in arm A but 9 (36%) patients developed rash in arm B. DFS at 12 months was higher in CP arm B compared to arm A but not statistically significant. Conclusion: This study showed addition of CP to RT improved LRC with increased and manageable adverse effects.
Monopolar transurethral resection of the prostate in patients over 80 years of age: A retrospective, single-centre study
Background: Bladder outlet obstruction (BOO) secondary to benign prostatic enlargement (BPE) is common in elderly men, with a significant impact on quality of life. Transurethral resection of the prostate (TURP) remains the standard surgical treatment, but its safety in patients over 80 years of age is debated due to comorbidities and higher perioperative risks. Aims and Objective: To evaluate the safety, efficacy, and functional outcomes of monopolar TURP in men aged ≥80 years. Materials and Methods: We retrospectively reviewed records of men aged over 80 years who underwent monopolar TURP at our center between January 2022 and January 2025. Data collected included age, prostate size, presentation, comorbidities, medications, perioperative complications, and catheter-free trial outcomes. Surgical success was defined as a satisfactory patient-reported outcome, successful catheter-free trial, and post-void residual (PVR) <100 mL at 1 month. Results: Twenty-nine patients (mean age 86.8 years) were included. Fourteen (48.3%) presented with lower urinary tract symptoms and 15 (51.7%) with acute urinary retention. The mean prostate size was 70.8 g. All patients achieved catheter-free status post-operatively, with a mean PVR of 41.2 mL. The complication rate was 6.9% (urethral stricture in one patient, meatal stenosis in one patient); all were minor and manageable. No cases of transurethral resection syndrome, blood transfusion, reoperation, or perioperative mortality occurred. One patient was incidentally diagnosed with prostate carcinoma on histopathology. Conclusion: Monopolar TURP in men over 80 years is a safe and effective procedure with excellent functional outcomes, low morbidity, and no perioperative mortality. Careful patient selection, perioperative optimization, and meticulous surgical technique are key to achieving favorable outcomes in this high-risk group.
Point-of-care ultrasound in acute kidney injury: A single-center study
Background: Acute kidney injury (AKI) is a serious condition with a high mortality rate, necessitating prompt radiological assessment for effective management. Delays in radiologist evaluation can impede the initiation of treatment. Nephrologists are increasingly utilizing point-of-care ultrasound (POCUS) for bedside evaluations, expediting treatment decisions. POCUS enhances physical examinations and is valuable in nephrology for guiding procedures and diagnosing kidney disease. Aims and Objectives: This study aimed to use POCUS to assess kidney echogenicity, size in various AKI causes, post-renal obstructions, volume status through the inferior vena cava (IVC), and lung ultrasonography (USG) findings and to compare these findings with clinical assessments. Materials and Methods: In this prospective observational study, 50 patients with AKI were clinically categorized upon admission into euvolemic, hypervolemic, or hypovolemic groups based on physical examination. POCUS was used to assess renal cortical echogenicity, bladder outlet obstruction, and volume status using IVC size and lung USG. Correlations between clinical and POCUS-assessed volume status were compared. Results: The mean age was 48.8 years, with 64% male (n=32). POCUS revealed increased renal echogenicity in three patients (6%) and obstructive nephropathy in six patients (12%). Clinical assessments correlated with POCUS findings in 69.2% of euvolemic, 93.3% of hypervolemic, and 88.9% of hypovolemic patients (P<0.0001). Conclusion: The strong correlation between POCUS findings and clinical assessments underscores its reliability as a rapid, non-invasive tool for evaluating volume status in patients with AKI, supporting treatment decisions such as dialysis and hydration.
Pattern of mastoid pneumatization among the East Indian population: A cross-sectional radiological study
Background: The pneumatic air cells of the mastoid of the temporal bone play an important role in the function of the ear and its diseases. The extent and distribution of mastoid air cell pneumatization vary among individuals and are influenced by some genetic and environmental factors. Aims and Objectives: This study was conducted to analyze the types of mastoid pneumatization based on sex and age among the East Indian population, and to report on asymmetry. Materials and Methods: The present study was conducted on 58 males and 39 females without any evidence of middle ear disease. The bilateral X-ray plates of the mastoid region of 97 study subjects were analyzed, and a dataset was prepared across the gender and age groups. Results: The pneumatic type of mastoid was the most common variety, followed by the diploic mastoid. The same pattern was seen among males and females. The diploic type of mastoid was more common among females than among males. Among all age groups, pneumatic mastoid was the most common type, followed by diploic and sclerotic types. No statistically significant data were seen across the genders and ages. Conclusion: In the absence of ear disease, the pneumatic mastoid is the most common pattern of mastoid pneumatization in the East Indian population, regardless of sex or age. The study results provide assurance to clinicians regarding the anatomical consistency of the pneumatization of the mastoid in the management of the disease that surrounds this region. It also proposed the relevance of classic radiological assessment in epidemiological research, while highlighting the need for ongoing, high-resolution morphometric studies of mastoid pneumatization in clinical research.
Stoma reversals following open abdomen management: A retrospective study from Eastern India
Background: Stoma creation during open abdomen (OA) management is often necessary to reduce sepsis and protect anastomoses. However, there is no evidence on reversal timing and outcomes in this high-risk group. Aims and Objectives: To evaluate stoma-related complications, reversal timing, operative outcomes, and post-reversal morbidity in patients who underwent stoma formation during OA management. Materials and Methods: We conducted a retrospective analysis of 32 patients who underwent stoma reversal following OA management between May 2022 and April 2025, with follow-up until June 2025. Patient demographics, nutritional parameters, comorbidities, stoma type, interval to reversal, and intra- and post-operative outcomes were analysed. Statistical comparisons were performed using the Mann–Whitney U and Fisher’s exact tests with Bonferroni correction by the Statistical Package for Social Sciences version 26 (IBM, NY, USA). Results: Of 32 patients, 6 had jejunostomies, 17 had ileostomies, and 9 had colostomies. Colostomy patients were older (mean 59.9 years) than ileostomy (55.8 years) and jejunostomy (50.8 years). Jejunostomy patients had poorer nutritional parameters. Median wait times were significantly shorter for jejunostomy compared with ileostomy (P=0.0142) and colostomy (P=0.0015). Ileostomy reversals had the shortest operative times (85 min vs. 117.5 min for jejunostomy, P=0.0117; 150 min for colostomy, P=0.0006). Stoma-related complications were most frequent in jejunostomy (83%), compared with ileostomy (29%) and colostomy (22%) (P=0.024). Post-reversal complications occurred in 66.7% of jejunostomy, 41.2% of ileostomy, and 44.4% of colostomy patients, respectively. One mortality occurred in the jejunostomy group due to hypokalemia. Conclusion: Jejunostomy patients experienced the highest morbidity requiring earlier reversal. Ileostomy reversals had shorter operative times and lower complication rates. Colostomies had the longest wait time and demonstrated broader post-operative morbidity. Stoma reversal following OA management requires balancing early closure to prevent ongoing stoma-related morbidity against delayed reversal to minimize risks from adhesions and sepsis. Larger prospective studies are required to optimize reversal timing and improve outcomes.