Journal of Recent Advances in Applied Sciences (pISSN 0970-1990)
JRAAS (pISSN 0970-1990) is an Indexed Journal. The first issue of Journal was published in 1986. JRAAS publishing Special Issues in Medicine & Surgery (Volume 40) on the occasion of completing it’s 40 year of publishing. Journal was being successfully run and managed by succeeding editors and thus, achieved the indexing in Clarivate Analytics Science Citation Index (SCI) with an Impact Factor of 0.5 during year 2012. Journal is also indexed in NCBI-NLM Catalogue; EBSCOhost database (ebscohost.com); CAS Source Index (CASSI); German Union Catalogue of Serials (ZDB); hbz union database, Germany, ZB MED search Portal Germany etc. Further, more than 150 leading Universities from USA, Germany, United Kingdom, Canada, New Zealand and South Africa have subscribed to the print issues of the journal. For more details visit the abstracting and indexing webpage of the journal. Abstracting and Indexing For detailed abstracting and indexing please about the journal section. https://internationalmedicalpublishing.com/index.php/JRAAS/about
Spectrum of Fibroepithelial Breast Lesions in a Single Patient: From Fibroadenoma to Malignant Phyllodes Tumor
Introduction: Fibroepithelial lesions of the breast comprise a diverse group of biphasic tumors ranging from benign fibroadenomas to phyllodes tumors, which are further categorized as benign, borderline, and malignant. Although fibroadenomas are common benign breast lesions, phyllodes tumors are relatively rare and may clinically and radiologically mimic fibroadenomas, making accurate diagnosis challenging. The coexistence of multiple fibroepithelial tumor types in a single patient is exceptionally uncommon and highlights the complexity of these lesions. Aim & Objective: To present a rare case demonstrating the complete histopathological spectrum of fibroepithelial breast lesions in a single patient and to emphasize the importance of careful pathological evaluation for appropriate diagnosis and management. Material & Methods: A 46-year-old female presented with bilateral breast lumps clinically suggestive of benign breast lesions. Radiological evaluation favored fibroadenomas. Surgical excision of the breast masses was performed, followed by detailed histopathological examination of all excised specimens. Results: Histopathological analysis revealed three distinct fibroepithelial lesions within the same patient, including fibroadenoma, benign phyllodes tumor, and malignant phyllodes tumor. The lesions showed overlapping radiological appearances, contributing to diagnostic difficulty. Microscopic evaluation demonstrated varying stromal cellularity, atypia, mitotic activity, and tumor margins corresponding to the different pathological entities. The presence of a malignant phyllodes tumor necessitated close clinical follow-up and further oncological management. Conclusion: This rare case illustrates the broad histopathological spectrum of fibroepithelial breast lesions and highlights the limitations of radiological diagnosis alone. Comprehensive histopathological assessment remains essential for accurate classification, prognostication, and treatment planning. Early recognition of
Fibroepithelial lesion, Fibroadenoma, Phyllodes tumor, Malignant phyllodes, Breast lump, Histopathology
Copyright (c) 2026 Journal of Recent Advances in Applied Sciences (pISSN 0970-1990)
A Retrospective Study of Fetomaternal Outcome In Placental Abruption - A Case Series
Introduction: Placental abruption is a significant obstetric emergency and a leading cause of antepartum hemorrhage, characterized by premature separation of the placenta from the uterine wall. It is associated with high maternal and perinatal morbidity and mortality, particularly in developing countries. This study aims to evaluate the fetomaternal outcomes in cases of placental abruption. Aims & Objectives: To evaluate the clinical presentation, risk factors, management, and fetomaternal outcomes in patients with placental abruption. Material & Methods: This retrospective case series was conducted at a tertiary care center over six months (January to June 2025). A total of nine pregnant women diagnosed with placental abruption were included. Clinical presentation, risk factors, management, and maternal and fetal outcomes were analyzed and summarized. Results: Most patients were aged 21–35 years. Hypertensive disorders of pregnancy and polyhydramnios were the most common risk factors. The predominant presenting symptoms included vaginal bleeding, abdominal pain, and decreased or absent fetal movements. Many patients had anemia, tachycardia, and elevated blood pressure. Emergency cesarean section was performed in cases with a live fetus, while vaginal delivery was preferred in stable patients with intrauterine fetal demise. Blood loss ranged from 1 to 2.5 liters, and all patients required blood transfusions. Maternal complications included postpartum hemorrhage, acute kidney injury, disseminated intravascular coagulation, and one case required peripartum hysterectomy. Perinatal outcomes were poor, with a high incidence of intrauterine fetal death and an overall mortality rate of 67%. Conclusion: The Placental abruption remains a life-threatening condition with significant adverse maternal and perinatal outcomes. Early diagnosis, timely referral, adequate antenatal care, and availability of blood transfusion services are crucial in improving the survival and reducing complications.
Placental abruption; Antepartum hemorrhage; Maternal outcome; Perinatal mortality; Hypertensive disorders of pregnancy
Outcome of Women Presenting with Ectopic Pregnancy & It’s Management - A Case Series
Introduction: Ectopic pregnancy is a potentially life-threatening condition characterized by implantation of the fertilized ovum outside the uterine cavity, most commonly in the fallopian tube. Its incidence has increased due to rising risk factors such as pelvic inflammatory disease, assisted reproductive techniques, and prior tubal surgeries. It contributes significantly to maternal morbidity and first-trimester mortality, often presenting with nonspecific symptoms that delay diagnosis and management. Aims & Objectives: To evaluate the clinical presentation, diagnosis, management strategies, intraoperative findings, maternal complications, and outcomes of ectopic pregnancy cases. Material & Methods: This retrospective case series was conducted at a tertiary care center from January 2025 to June 2025. A total of 12 cases diagnosed with ectopic pregnancy were included. Clinical presentation, diagnostic challenges, type of conception, site of ectopic implantation, management strategies, intraoperative findings, and maternal outcomes were analyzed. Ultrasonography and serum beta-hCG levels were used for diagnosis, and treatment decisions were based on clinical condition. Results: Most patients belonged to the 20–30-year age group. Spontaneous conception accounted for 10 cases, while 2 followed induced conception. The majority (11/12) were ruptured ectopic pregnancies, with significant hemoperitoneum in 6 cases requiring blood transfusion. Tubal ectopic pregnancy was the most common (10 cases), followed by one cervical and one cornual ectopic pregnancy. Surgical intervention was the mainstay of treatment, with salpingectomy performed in most cases. One case required hysterectomy due to severe bleeding, and there was one maternal mortality due to delayed referral and hypovolemic shock. Conclusion: Ectopic pregnancy remains a critical obstetric emergency with high morbidity and mortality. Early diagnosis using clinical suspicion, ultrasonography, and beta-hCG estimation is essential. Prompt surgical intervention in unstable patients is lifesaving. Multidisciplinary management and early referral play a crucial role in improving maternal outcomes.
Ectopic pregnancy, Tubal rupture, Hemoperitoneum, Salpingectomy, Maternal mortality
Mullerian Anomalies & Delivery Outcome - A Case Series
Introduction: Müllerian anomalies are congenital malformations of the female genital tract resulting from abnormal development, fusion, or resorption of the paramesonephric ducts. Though uncommon, they are clinically important because they are associated with malpresentation, preterm delivery, operative intervention, and adverse perinatal outcomes. Evaluating their impact on pregnancy and delivery is essential for improving antenatal surveillance and obstetric management. Aim & Objective: To evaluate the spectrum of Müllerian anomalies and their impact on delivery outcome, and to correlate anomaly type with obstetric complications, fetal presentation, preterm birth, low birth weight, and maternal and neonatal outcome. Materials & Methods: This retrospective case series was conducted at KIMS, Koppal, from March 2024 to March 2025 among 10 pregnant women with Müllerian anomalies diagnosed before pregnancy, antenatally, or intraoperatively. Pregnancies beyond 28 weeks were evaluated for demographic profile, anomaly type, clinical presentation, delivery details, intraoperative findings, and maternal and neonatal outcomes. Results: Equal proportions of women belonged to 20 to 24 years and 25 to 29 years age groups. Multigravida constituted 70%, previous abortion was noted in 40%, and hypertensive disorders in 30%. Arcuate uterus was the commonest anomaly (50%), followed by bicornuate uterus (20%). Breech/podalic presentation occurred in 70%, while 70% delivered after 37 weeks. Caesarean section was performed in all cases. Postpartum hemorrhage occurred in 30%, and blood transfusion was required in 10%. Low birth weight was seen in 30%, SNCU admission in 50%, and neonatal survival was 100%. Conclusion: Müllerian anomalies significantly influence delivery outcome by increasing malpresentation, operative delivery, and selected maternal and neonatal risks. Early diagnosis and careful obstetric management can improve fetomaternal outcome.
Müllerian anomalies; Pregnancy outcome; Caesarean section; Malpresentation; Perinatal outcome
Spectrum & Clinicopathological Profile of Leukemia in a Tertiary Care Center in Northern India
Introduction: Leukemia comprises a heterogeneous group of hematological malignancies with varying clinical and epidemiological patterns across different regions. Understanding the local distribution of leukemia subtypes is important for improving early diagnosis, treatment strategies, and patient management. Aim & Objectives: This study aimed to evaluate the spectrum of leukemia and analyze its distribution according to age and gender in a tertiary care center in Northern India. Material & Methods: A retrospective observational study was conducted on 108 diagnosed cases of leukemia. Diagnosis was established using hematological, morphological, and cytochemical evaluation. Demographic and clinical details, including age, gender, and leukemia subtype, were collected from hospital records and analyzed statistically using the Chi-square test, with p < 0.05 considered statistically significant. Results: Chronic leukemias accounted for most cases (86.11%), with Chronic Myeloid Leukemia being the predominant subtype (75.92%), followed by Chronic Lymphocytic Leukemia (10.18%). Among acute leukemias, Acute Lymphoblastic Leukemia (9.25%) was slightly more common than Acute Myeloid Leukemia (4.62%). A mild male predominance was observed (M: F = 1.28:1), although no significant association was found between gender and leukemia subtype (p = 0.900). Age-wise distribution showed a significant association with leukemia subtype (p < 0.001), with ALL predominating in children, CML in middle-aged adults, and CLL in elderly individuals. Conclusion: Chronic leukemias, particularly CML, were the most common leukemias observed in this region, with distinct age-related patterns across different subtypes.
Leukemia; Chronic Myeloid Leukemia; Acute Leukemia; Epidemiology; Northern India; Hematological Malignancies
Prevalence of Hypoalbuminemia Among Older Adults Admitted with Intertrochanteric Fracture & Its Impact on Clinical Outcome
Introduction: Intertrochanteric fractures in older adults are associated with high morbidity and mortality. Nutritional status, particularly serum albumin level, is an important indicator of both nutritional reserve and overall systemic health. Aim & Objectives: To determine the prevalence of hypoalbuminemia among elderly patients with intertrochanteric fractures and to evaluate its association with clinical outcomes. Materials & Methods: A hospital-based cross-sectional observational study was conducted on 120 patients aged ≥60 years with radiologically confirmed intertrochanteric fractures. Serum albumin levels were measured within 24 hours of admission. Hypoalbuminemia was defined as serum albumin ≤3.5 g/dL. Nutritional status was assessed using the Mini Nutritional Assessment (MNA) score. Clinical outcomes included functional recovery, in-hospital mortality, and duration of hospital stay. Results: Hypoalbuminemia was observed in 73.3% of patients. It showed a significant association with poor functional outcomes and prolonged hospital stay (p < 0.05). However, no significant association was found between hypoalbuminemia and mortality. Additionally, MNA scores did not show a significant correlation with serum albumin levels. Conclusion: Hypoalbuminemia is highly prevalent among elderly patients with intertrochanteric fractures and serves as an important predictor of poor functional recovery and increased hospital stay. Early identification and nutritional intervention may help improve clinical outcomes in this high-risk population.
Hypoalbuminemia, Intertrochanteric fracture, Elderly, Nutritional status, Clinical outcome.
Green & Sustainable Radiology: Advancing One Health Through Energy Efficiency & Environmental Responsibility
Introduction: Radiology is essential to modern healthcare, but advanced imaging modalities such as magnetic resonance imaging and computed tomography are highly energy-intensive. Continuous equipment operation, cooling systems, and digital infrastructure significantly increase electricity use and carbon emissions. With growing climate concerns and healthcare energy demands, integrating sustainability into radiology practice is crucial within the One Health framework. Aim & Objectives: This study aimed to evaluate the electricity consumption profile of a hospital radiology department and assess the impact of structured energy-efficiency interventions. The objectives were to identify major energy-consuming equipment, quantify baseline electricity use, and determine potential reductions achievable through uniform efficiency measures. Materials & Methods: This observational, evidence-based assessment evaluated the monthly electricity consumption of radiology and HVAC equipment before and after a standardized 30 percent energy-efficiency intervention. Equipment-wise power use was recorded, categorized, and compared to determine absolute and relative reductions in energy demand. Results: Baseline analysis demonstrated a highly skewed consumption pattern, with the MRI system accounting for more than half of total monthly electricity use, followed by air conditioning and CT scanners. After intervention, total monthly consumption decreased from 24,419 kWh to 17,094 kWh, achieving a net reduction of 7,325 kWh. The largest absolute savings were observed in MRI, HVAC systems, and CT scanners, while low-power devices showed minimal impact. Conclusion: Targeted energy optimization in high-load imaging and climate control systems can produce substantial electricity savings without compromising diagnostic services. Adoption of sustainable radiology practices represents a practical pathway to reduce healthcare carbon footprint while supporting environmental and public health goals.
Green radiology; Energy efficiency; MRI; One health; Sustainability
A Massive Ovarian Mixed Germ Cell Tumour Mimicking Severe Pre-eclampsia in an Adolescent Pregnancy: A Case Report
Introduction: Co-existence of a malignant ovarian germ cell tumour with advanced pregnancy is rare and poses significant diagnostic challenges. Physiological changes of pregnancy, along with the mechanical and biochemical effects of a large adnexal mass, may mimic acute obstetric conditions and delay diagnosis. Case presentation: A 17-year-old primigravida at 27 weeks 3 days of gestation presented with progressive abdominal distension, orthopnoea, and oliguria for 10 days. She had hypertension (150/90 mmHg) with 2+ proteinuria, suggestive of severe pre-eclampsia. Imaging (ultrasound and MRI) revealed a large solid-cystic pelvi-abdominal mass (167 × 210 × 100 mm) with fat, calcifications, ascites, and bilateral pleural effusion. Cytology of ascitic and pleural fluid was negative for malignancy. Tumour markers showed markedly elevated AFP (2382 ng/mL) along with raised LDH, CA-125, and CEA. After receiving antenatal corticosteroids and magnesium sulphate, she had a spontaneous preterm vaginal delivery of a live female neonate (935 g). Subsequently, fertility-sparing staging laparotomy with left salpingo-oophorectomy, omentectomy, pelvic lymph node sampling, and peritoneal washings was performed with complete macroscopic cytoreduction. Result: Histopathology confirmed a mixed germ cell tumour comprising 90% grade 3 immature teratoma and 10% yolk sac tumour, classified as FIGO stage IA (pT1aN0). Postoperative tumour markers showed a rapid decline. The patient was started on adjuvant multi-agent chemotherapy along with a GnRH agonist for ovarian protection. Conclusion: A large adnexal germ cell malignancy can mimic hypertensive disorders of pregnancy, leading to diagnostic delays. Early use of imaging, appropriate interpretation of tumour markers in pregnancy, and a multidisciplinary approach are crucial for timely diagnosis, effective oncological management, and favorable maternal and neonatal outcomes.
Immature teratoma; Mixed germ cell tumour; Pregnancy; Adolescent; Pre-eclampsia; Fertility-sparing surgery.
Impact of Prior COVID-19 on the Demographics & Exposure Pattern of Tuberculosis Patients: A Cross-Sectional Study
Introduction: Tuberculosis (TB) remains a major global public health concern. Although TB mortality had been declining until 2019, it reversed during 2020–2021, as highlighted in the Global Tuberculosis Report 2022, largely due to disruptions caused by the COVID-19 pandemic. While COVID-19 has affected TB control programs worldwide, limited data exist on its impact on the demographic and exposure profiles of TB patients, especially in endemic regions. Aim & Objective: To assess the impact of prior COVID-19 infection on the demographics and exposure patterns of TB patients. Materials & Methods: This hospital-based cross-sectional study included 482 adult TB patients at a tertiary care center (January 2025–January 2026). Data on age, sex, previous TB history, TB contact, prior COVID-19 infection, vaccination status, steroid use, and hospitalization were collected. Statistical analysis included descriptive statistics, Chi-square/Fisher’s exact test, and binary logistic regression to identify predictors of previous TB history and TB contact. Results: The mean age was 36.3 ± 15.98 years, with most patients aged 18–27 years (34.0%). Females constituted 63.3% of cases. Previous TB history was present in 54.4%, and 57.9% reported TB contact. Prior COVID-19 infection was documented in 57.3% of patients. A significant association was observed between TB contact and previous TB history (p < 0.001). Logistic regression showed that TB contact increased the odds of previous TB by approximately fourfold (OR = 4.04, 95% CI: 2.75–5.92). Conclusion: COVID-19 related factors showed no significant association with TB history or contact. Traditional risk factors, particularly TB contact and prior TB, remain key determinants, emphasizing the need to strengthen core TB control strategies.
Tuberculosis, COVID-19, Mycobacterium Tuberculosis contact, Epidemiology, Cross-sectional study
Needling Infertility: Diagnostic Utility of Fine Needle Aspiration Cytology (FNAC) of Testes in the Evaluation of Male Infertility
Introduction: Male infertility affects nearly 15% of reproductive-age couples, with male factors contributing to about 50% of cases. Azoospermia, seen in 10–15% of infertile men, requires differentiation into obstructive and non-obstructive types. While a testicular biopsy is definitive, it is invasive. Fine Needle Aspiration Cytology (FNAC) offers a minimally invasive, cost-effective alternative for assessing spermatogenesis. Aim & Objectives: This study aimed to evaluate the diagnostic role of testicular FNAC in infertile males by classifying cytological patterns, correlating findings with semen analysis and hormonal profiles, and distinguishing obstructive from non-obstructive infertility. Material & Methods: A 12-month prospective study was conducted at GSVM Medical College and LLR Hospitals, Kanpur, including 140 infertile males with azoospermia or severe oligospermia (<5 million/mL). All underwent semen analysis (WHO criteria), hormonal assays (FSH, LH, testosterone, prolactin), and scrotal ultrasonography. FNAC was performed using a 23–25G needle. Smears were stained with May-Grünwald-Giemsa, Papanicolaou, and H&E, and categorized into five groups: normal spermatogenesis, hypospermatogenesis, maturation arrest, Sertoli cell-only syndrome, and testicular atrophy. Results: Among the 140 patients evaluated, normal spermatogenesis was observed in 29.3% of cases, all presenting with azoospermia and normal FSH levels, suggesting obstructive azoospermia. Hypospermatogenesis was also identified in 29.3% of patients and was commonly associated with borderline elevated FSH levels and oligospermia. Maturation arrest was the most frequent finding, seen in 35% of cases, predominantly in early stages, and correlated with elevated FSH and low testosterone levels. Sertoli cell-only syndrome was diagnosed with 0.7% of patients, all of whom had markedly elevated FSH levels and azoospermia. Testicular atrophy was observed in 5% of cases, indicating advanced testicular failure. Conclusion: FNAC is a safe, effective first-line diagnostic tool for evaluating male infertility, enabling accurate classification and guiding appropriate management, especially in resource-limited settings.
Testicular FNAC, Male infertility, Azoospermia, Sertoli Cell-Only Syndrome, Maturation Arrest, Hypospermatogenesis, Testicular Cytology, Non-obstructive Azoospermia.
Evaluation of P-53 & E-Cadherin Status in Breast Carcinoma & Its Correlation with Histological Grading
Introduction: Breast carcinoma is the most frequently diagnosed malignancy among women worldwide and a leading cause of cancer-related mortality. Although histological grading remains important for prognostic assessment, variability in tumor behavior within similar grades necessitates the evaluation of additional molecular biomarkers. Aim & Objectives: To evaluate the expression of p53 and E-Cadherin in breast carcinoma and to correlate their expression with histological subtype and tumor grade. Material & Methods: This study included 100 histopathologically confirmed cases of breast carcinoma. Immunohistochemical analysis for p53 and E-Cadherin was performed on paraffin-embedded tissue sections. Histological grading was carried out using the Modified Bloom–Richardson (Nottingham) grading system. The expression patterns of both markers were correlated with histological subtype and grade. Results: p53 positivity was observed in 58% of cases and showed a significant association with invasive ductal carcinoma and higher tumor grades. Altered E-Cadherin expression, including partial and complete loss, was noted in a considerable number of cases, with complete loss predominantly seen in invasive lobular carcinoma. Increasing loss of E-Cadherin expression was significantly associated with higher histological grades. Combined evaluation of p53 positivity and E-Cadherin loss demonstrated a stronger correlation with tumor grade and better diagnostic performance compared to individual markers. Conclusion: The combined assessment of p53 and E-Cadherin provides better insight into tumor aggressiveness and correlates significantly with histological grading. Integration of these molecular markers with routine histopathology may improve prognostic stratification in breast carcinoma.
Breast carcinoma, p53, E-Cadherin, Histological grading, Immunohistochemistry, Nottingham grading system, Prognostic markers.
Beyond Appendicitis: A Rare Case of Succenturiate Placenta Increta Presenting as Acute Abdomen
Introduction: Placenta accreta spectrum (PAS) is a severe obstetric condition characterized by abnormal adherence and invasion of the placenta into the myometrium, often leading to massive hemorrhage and significant maternal morbidity. Despite advances in antenatal imaging, atypical presentations remain diagnostically challenging, particularly in cases with placental morphological variations such as succenturiate lobes. These variants may obscure diagnosis and delay timely intervention. Case Presentation: A 34-year-old multigravida at 32 weeks of gestation presented with acute abdominal pain, initially suggestive of a non-obstetric cause. Initial clinical evaluation and imaging were inconclusive, and the patient was managed conservatively. Due to worsening abdominal pain and rising clinical suspicion, repeat imaging was performed. This revealed a previously undetected succenturiate placental lobe located in the lower uterine segment, showing features consistent with placenta increta, along with hemoperitoneum. The main placental mass was situated anteriorly in the upper uterine segment, contributing to the missed diagnosis in earlier scans. Results: Given the high risk of catastrophic hemorrhage, an emergency cesarean section was undertaken. Intraoperative findings confirmed significant placental invasion with massive hemorrhage, necessitating obstetric hysterectomy and transfusion of blood products. With prompt multidisciplinary management, the patient had an uneventful postoperative recovery. Conclusion: This case highlights the need to consider placenta accreta spectrum in the differential diagnosis of acute abdomen during pregnancy, especially in patients with a history of prior uterine surgery. Thorough placental evaluation, heightened clinical suspicion, and timely multidisciplinary intervention are essential to optimize maternal and fetal outcomes in such rare and life-threatening scenarios.
Placenta accreta spectrum; Placenta increta; Succenturiate placenta; Hemoperitoneum; Acute abdomen in pregnancy; Obstetric hemorrhage
Missed on Imaging, Found on Laparoscopy: A Case of Primary Infertility
Introduction: Infertility is a significant global reproductive health concern, affecting approximately 10–15% of couples, with female factors contributing to nearly half of cases. Although imaging modalities such as ultrasonography and hysterosalpingography (HSG) are widely used as first-line diagnostic tools, they may fail to detect subtle uterine anomalies, tubal pathologies, or peritoneal conditions. As a result, a considerable number of patients are categorized under unexplained infertility. Diagnostic hysterolaparoscopy has emerged as gold standard for comprehensive infertility evaluation, as it allows direct visualization of pelvic organs along with opportunity for simultaneous therapeutic intervention. Aim & Objective: To emphasize the diagnostic value of laparoscopy in identifying pelvic and uterine abnormalities that are not detected by conventional imaging techniques in patients with long-standing primary infertility. Case Presentation: This case involves a 30-year-old woman presenting with primary infertility of eight years’ duration. Preliminary investigations, including hormonal assays, transvaginal ultrasonography, and partner semen analysis, were within normal limits. HSG findings suggested bilateral cornual block. To further evaluate the underlying cause, the patient underwent diagnostic hysterolaparoscopy with chromopertubation under anesthesia. Results: Hysteroscopic examination was inconclusive due to a markedly narrow (pinpoint) internal os, which limited proper uterine cavity assessment. However, laparoscopic evaluation revealed a bicornuate uterus with a non-communicating rudimentary horn-an anomaly not identified in previous imaging studies. Additionally, intra-abdominal findings raised suspicion of abdominal tuberculosis. These combined findings led to a significant revision of the initial diagnosis and influenced subsequent management planning. Conclusion: Diagnostic laparoscopy plays a pivotal role in uncovering hidden pelvic and uterine abnormalities in infertility cases where non-invasive modalities yield inconclusive or misleading results. Early implementation of hysterolaparoscopy, particularly in long-standing infertility, enhances diagnostic accuracy, enables timely intervention, supports more effective, individualized treatment strategies.
Primary infertility, Bicornuate uterus, Diagnostic laparoscopy, Hysterosalpingography, Genital tuberculosis, Unexplained infertility
Giant Fibroadenoma with TP53 Pro/Pro Variant in a 19-Year-Old: Case Report & Implications for Early Risk Stratification
Introduction: Fibroadenomas are common benign breast tumors, particularly in young women, while giant fibroadenomas, defined as those exceeding 5 cm, are rare. TP53 mutations are generally associated with malignancies and are seldom observed in benign breast lesions. The Arg72Pro polymorphism of TP53 is a low-penetrance variant that may modulate cancer susceptibility. Aim & Objectives: This report presents a rare case of a giant fibroadenoma harboring a TP53 codon 72 Pro/Pro polymorphism and explores its potential relevance in early cancer risk stratification. Material & Methods: A 19-year-old female presented with a palpable breast lump. Surgical excision was performed, and histopathology confirmed a giant fibroadenoma. Immunohistochemistry for p53 protein was carried out to assess protein expression. Genomic DNA from peripheral blood was analyzed for TP53 mutations, focusing on codon 72 polymorphism. A literature review was conducted to contextualize TP53 variants in benign breast disease. Results: The excised tumor measured 7.5 cm and displayed benign histology without atypia or malignancy. p53 immunohistochemistry was negative, indicating no protein accumulation. Genetic analysis revealed a homozygous Pro/Pro genotype at codon 72, with no pathogenic high-penetrance TP53 mutations detected. Previous studies suggest that this variant may modestly increase cancer susceptibility in specific populations. Conclusion: This case demonstrates a rare coexistence of a TP53 Pro/Pro polymorphism in a benign giant fibroadenoma. While the lesion itself was benign, the presence of a low-penetrance TP53 variant may provide insight into subtle cancer predisposition. These findings underscore the potential role of such polymorphisms as early biomarkers for risk assessment and highlight the need for further research into their prognostic and preventive implications.
Giant fibroadenoma, TP53 polymorphism, Arg72Pro, Benign breast lesion, Cancer risk, p53.
Comparative Study of Thyroid Profile in Patients of Diabetic & Non-Diabetic Chronic Kidney Disease
Introduction: Chronic kidney disease (CKD) is a progressive disorder leading to impaired renal function, often complicated by thyroid dysfunction. Diabetes is a major contributor to CKD and may exacerbate thyroid abnormalities, which include subclinical hypothyroidism, overt hypothyroidism, and subclinical hyperthyroidism. Thyroid dysfunction in CKD patients can worsen clinical outcomes, highlighting the need for early detection and management. Aim & Objective: To compare thyroid profiles in diabetic and non-diabetic CKD patients and assess the prevalence and distribution of thyroid dysfunction across genders and CKD stages. Materials & Methods: An observational, comparative study was conducted at I.G. ESIC Hospital, Delhi, including 90 patients (>18 years) divided equally into diabetic and non-diabetic CKD groups. Blood samples were analyzed for Free T3, Free T4, and TSH using ELISA. Patients with known thyroid disorders, severe trauma, liver disease, nephrotic syndrome, or medications affecting thyroid function were excluded. Data were analyzed using SPSS, with significance set at p<0.05. Results: Thyroid dysfunction was more prevalent in diabetic CKD patients and females across both groups. Subclinical hypothyroidism was the most common abnormality, followed by overt hypothyroidism and subclinical hyperthyroidism. Euthyroid status was more frequent in males and non-diabetic CKD patients. Thyroid dysfunction increased with CKD severity, peaking in Stage 5, with diabetic patients consistently showing higher prevalence than non-diabetics. Conclusion: Thyroid dysfunction is common in CKD, particularly among diabetic patients and females, and correlates with disease severity. Routine thyroid screening and early management are recommended to improve outcomes in CKD patients.
Chronic kidney disease, Diabetes, Thyroid dysfunction, Subclinical hypothyroidism, Euthyroid, CKD stages.
Correlation Between Hyperferritinemia & Microvascular Complications of Type 2 Diabetes Mellitus
Introduction: Diabetes mellitus is a major metabolic disorder associated with microvascular complications such as retinopathy and nephropathy. Emerging evidence suggests that elevated serum ferritin, a marker of iron stores and inflammation, may play a role in the pathogenesis of these complications. Aim & Objective: To assess serum ferritin levels in patients with type 2 diabetes mellitus (T2DM) and evaluate its association with microvascular complications. Materials & Methods: This observational cross-sectional study was conducted over 18 months in the Department of General Medicine, IG ESIC Hospital, Jhilmil, Delhi. A total of 351 patients with T2DM were included based on predefined inclusion and exclusion criteria. After obtaining informed consent, detailed clinical history, examination, and investigations including serum ferritin, urine albumin–creatinine ratio, and fundoscopy were performed. Data was analyzed using SPSS, with appropriate statistical tests applied. A p-value <0.05 was considered significant. Results: A total of 351 patients with T2DM were included, with a mean age of 56.84±7.29 years and a male predominance (57.1%). Over half of the participants were overweight (52%). The prevalence of diabetic retinopathy and nephropathy was 23.7% and 22.6%, respectively. The mean serum ferritin level was 376.70±94.56 mcg/L. Significantly higher ferritin levels were observed in patients with diabetic retinopathy (416.93±106.15 vs 364.19±87.19 mcg/L; p=0.001) and nephropathy (400.53±112.68 vs 369.75±87.64 mcg/L; p=0.01). No significant association was found between serum ferritin and HbA1c levels (p=0.26). However, weak but statistically significant positive correlations were noted between ferritin and systolic blood pressure (r=0.12), diastolic blood pressure (r=0.11), platelet count (r=0.24), and urea levels (r=0.12). Conclusion: Hyperferritinemia is common in patients with T2DM and shows a weak association with diabetic retinopathy and nephropathy. Serum ferritin may serve as a potential marker for microvascular complications, although its relationship with glycemic control remains unclear.
Type 2 diabetes mellitus, Serum ferritin, Diabetic retinopathy, Diabetic nephropathy, Microvascular complications, Hyperferritinemia
A Prospective Study of Clinical Profile of Acute Appendicitis & Its Correlation with Ultrasonography Findings In Patients Admitted In J.A. Group of Hospitals, Gwalior
Introduction: Acute appendicitis remains one of the most common causes of acute abdomen requiring emergency surgical intervention. Despite classical signs and symptoms, its variable presentation can complicate diagnosis, leading to delayed treatment and serious complications. Ultrasonography (USG), being radiation-free, cost-effective, and readily available, plays a pivotal role in the diagnostic workup, especially in settings with limited access to advanced imaging. Aim & Objective: To study the clinical profile of patients with acute appendicitis and correlate clinical features with ultrasonographic findings to improve diagnostic precision and surgical outcomes. Materials & Methods: This prospective observational study was conducted over 18 months in the Department of General Surgery, J.A. Group of Hospitals, Gwalior, involving 89 patients aged 16–60 years with a provisional diagnosis of acute appendicitis. Detailed clinical history, physical examination, and ultrasonographic evaluations were performed. Diagnosis was confirmed intraoperatively. Data was analyzed for demographic distribution, clinical features, USG parameters, and outcomes. Results: Most patients were males (67.41%) aged between 21–30 years. All presented with central abdominal pain migrating to the right iliac fossa. McBurney’s point tenderness and rebound tenderness were noted in 100% of cases. Ultrasonographically, probe tenderness was present in 97.75%, and the mean appendiceal diameter was 7.43 ± 0.98 mm. All cases showed concordance between clinical, USG, and intraoperative diagnosis. There were no complications or mortality, and all patients had a full recovery. Conclusion: This study demonstrated a strong correlation between clinical signs and ultrasonographic findings in acute appendicitis. Combining both modalities improves diagnostic accuracy, enables timely surgical intervention, and reduces the risk of negative appendectomy and associated complications.
Acute Appendicitis; Ultrasonography; Clinical Correlation; Mcburney’s Tenderness; Probe Tenderness
Difference In Clinico - Etiological Profile of Neonatal Hyperbilirubinemia at A Tertiary Care Hospital
Introduction: Neonatal hyperbilirubinemia is one of the most common conditions requiring medical attention in the neonatal period. While most cases are physiological, delayed diagnosis and inappropriate management can lead to severe complications, including acute bilirubin encephalopathy and kernicterus. Aim & Objectives: To compare the clinico-etiological profile of neonatal hyperbilirubinemia between inborn and outborn neonates admitted to a tertiary care hospital and to identify key risk factors associated with pathological jaundice. Material & Methods: This hospital-based cross-sectional study was conducted in the Special Newborn Care Unit (SNCU) of a tertiary care hospital in Greater Noida over 12 months. Enrolled patients included 360 neonates ≤28 days with hyperbilirubinemia, either clinically suspected or biochemically confirmed. Data collection was done using a structured proforma, and etiological diagnosis was determined based on clinical and laboratory findings. Statistical analysis was done using SPSS v28.0; Chi-square and independent t-test were employed, with significance confirmed at p<0.05. Results: Of the 360 neonates included, 269 (74.7%) were inborn and 91 (25.3%) outborn. Pathological jaundice occurred more frequently among outborn neonates (60.4%) than inborn (28.6%) (p=0.001). In outborn infants, significantly higher prevalence for prematurity (36.1%), SGA status (56.1% vs 35.7%, p=0.002), and birth asphyxia (14.3% vs 4.8%, p=0.02) was observed. Neonatal sepsis was the most common etiology in outborn neonates (56.3%, p<0.001). On the other hand, ABO incompatibility (29.8%) and cephalohematoma (31.1%) were the principal factors among inborn infants. Total serum bilirubin levels were comparable between groups, though bilirubin testing was performed significantly earlier among inborn neonates (p=0.001). Conclusion: Significant differences exist in the etiological and clinical profile of hyperbilirubinemia between inborn and outborn neonates. Optimized early screening, infection control, and appropriate referral systems are mandatory in the reduction of preventable complications among outborn neonates.
Neonatal hyperbilirubinemia; Pathological jaundice; Inborn neonates; Outborn neonates; Neonatal sepsis; Prematurity; Small for gestational age; ABO incompatibility; Birth asphyxia; Tertiary care hospital.
Clinicopathological Spectrum of Intracranial Space-Occupying Lesions: A Tertiary Care Center Experience
Introduction: Intracranial space-occupying lesions (ICSOLs) comprise a heterogeneous group of neoplastic and non-neoplastic conditions with variable clinical presentation and biological behavior. Histopathological examination remains the gold standard for definitive diagnosis and grading, which directly influence management and prognosis. Aim & Objectives: To evaluate the demographic profile, clinical presentation, histopathological spectrum, and WHO grade distribution of ICSOLs in a tertiary care center, and to assess associations between clinical features, lesion type, and tumor grade. Material & Methods: This descriptive observational study included 100 consecutive ICSOL cases received in the Department of Pathology in collaboration with Neurosurgery. Clinical details and radiological information were recorded. Tissue specimens obtained by biopsy or excision were processed routinely and stained with hematoxylin and eosin; special stains and immunohistochemistry were performed where required. Lesions were classified according to WHO CNS tumor classification, and gliomas/meningiomas were graded as per WHO criteria. Data were analyzed using descriptive statistics, and χ² tests were applied to examine symptom–lesion associations and compare grade distribution; p < 0.05 was considered significant. Results: Mean age was 41.3 ± 18.7 years (range 2–70), with a peak in 31–40 years (22%). There was marginal male predominance (52%). Neoplastic lesions predominated (95%). Gliomas were most common (30%), followed by meningiomas (24%) and schwannomas (15%). Headache was the commonest symptom (62%), followed by seizures (34%) and visual disturbance (28%). Significant symptom associations were observed for headache, seizures, visual disturbance, focal neurological deficit, and fever (p < 0.05). WHO grade distribution differed significantly between gliomas and meningiomas, with high-grade tumors (Grade III–IV) significantly more frequent among gliomas (χ² = 14.22, p = 0.00016). Conclusion: ICSOLs in this cohort were predominantly neoplastic, with gliomas and meningiomas forming the major tumor burden. Clinicopathological correlations and WHO grading provide valuable diagnostic and prognostic insights, reinforcing the central role of histopathology in resource-limited settings.
Intracranial space-occupying lesion; CNS tumors; Histopathology; Glioma; Meningioma; WHO grading
A Comparative Study of Lichtenstein's Technique & Modified Lichtenstein Techniquein the Surgical Management of Inguinal Hernia
Introduction: Inguinal hernia repair is among the most commonly performed surgical procedures worldwide. The Lichtenstein tension-free mesh repair is the standard approach, though modifications have been introduced to reduce postoperative complications, chronic pain, and recurrence. Aim & Objective: This study aimed to compare the outcomes of the Modified Lichtenstein (ML) technique with the standard Lichtenstein (L) technique regarding postoperative complications, pain, and recurrence in patients undergoing open inguinal hernia repair. Materials & Methods: A prospective comparative study was conducted at the Department of Surgery, J.A. Group of Hospitals, G.R. Medical College, Gwalior. Seventy adult patients with inguinal hernia were randomly assigned to two groups: Group L (n=35) underwent standard Lichtenstein repair, and Group ML (n=35) underwent the Modified Lichtenstein repair. Demographic data, hernia type and side, intraoperative details, postoperative complications, pain scores, and recurrence were recorded and analyzed. Results: Both groups were comparable in age, gender, occupation, hernia type, and side, with most patients’ male (97.1%), aged 41–50 years (27.1%), right-sided hernia (55.7%), and indirect type (82.9%). All cases used spinal anesthesia and polypropylene mesh. Group L had significantly higher wound gaping (31.4% vs 5.7%, p=0.0118) and postoperative discharge (17.1% vs 0%, p<0.05). Seroma occurred in 11.4% of Group L and none in Group ML (p=0.1142). Mild pain predominated in Group ML at 24 and 48 hours, while moderate pain was more frequent in Group L. Recurrence at 11 months was observed in 17.1% of Group L and none in Group ML (p=0.0267). Conclusion: The Modified Lichtenstein repair is a safe, simple, and effective alternative to the standard technique, offering fewer postoperative complications, better pain control, and reduced short-term recurrence.
Inguinal hernia, Lichtenstein repair, Modified Lichtenstein technique, Mesh hernioplasty, Postoperative pain, Recurrence.
The Promise & Peril of Personalized Medicine
Editorial In the last decade, the term personalized medicine has transformed from a futuristic buzzword into a tangible revolution at the heart of modern healthcare [1]. Once, medicine was an art of averages - a prescription for the “typical” patient, a treatment designed to fit the majority. Today, fueled by advances in genomics, data analytics, and biotechnology, medicine is moving toward an era where treatment is not only based on disease but tailored to the individual who bears it [2-4]. The promise is profound. Genetic profiling can now identify how a person might respond to a drug, detect predispositions to conditions like cancer or Alzheimer's, and even guide preventive measures long before symptoms appear [1,3]. In oncology, for instance, targeted therapies have already begun to replace traditional chemotherapy with precision strikes on specific genetic mutations [10]. For many patients, this shift has meant longer survival and a better quality of life [5,10]. Yet, beneath this optimism lies a complex web of ethical, social, and economic challenges. Personalized medicine demands vast amounts of data - from genetic codes to lifestyle metrics - raising urgent questions about privacy and consent [8,9]. Who owns our genetic information? Can it be used to discriminate in employment or insurance? Furthermore, as cutting-edge therapies often carry astronomical price tags, there is a risk that personalized medicine could deepen the divide between those who can afford bespoke care and those who cannot [5,6]. Equally important is the issue of access to technology and representation in research. The genetic data driving personalized medicine has historically been derived largely from populations of European descent [7]. If this imbalance continues, the so-called “personalization” may fail to serve humanity in its entirety, leaving large segments of the global population without effective therapies [9]. To ensure that personalized medicine fulfills its humanitarian promise, we must marry scientific progress with ethical foresight [8]. Governments, researchers, and healthcare providers must establish transparent data governance systems, ensure equitable access to treatments, and promote diversity in biomedical research [7–9]. Education, too, plays a vital role - both for clinicians, who must interpret complex genetic information, and for patients, who deserve to understand their own biology [2,4]. Personalized medicine represents not merely a technological shift, but a philosophical one: a move toward seeing each patient as a unique biological narrative [11]. The challenge ahead lies in ensuring that this revolution serves not just the fortunate few but the collective human story. If guided wisely, personalized medicine may become not just the future of healthcare, but the future of humanity's relationship with itself [9].
A Community-Driven Analysis of Home Delivery Preference among Tribal Families in Bhimpur Block, Madhya Pradesh
Introduction: Despite the expansion of institutional maternal health services in India, home delivery remains prevalent among tribal communities. Socio-cultural traditions, geographical isolation, economic constraints, and trust in traditional birth attendants continue to influence childbirth practices. Understanding these factors is essential for designing culturally responsive maternal health interventions. Aim & Objectives: The study aimed to analyze the socio-cultural, geographical, economic, and trust-based factors influencing the preference for home delivery among tribal communities in the Bhimpur Block of Betul district, Madhya Pradesh. The objectives included assessing awareness of government maternal health schemes, access to health facilities, and the role of elders and traditional dais in childbirth decision-making. Materials & Methods: A cross-sectional descriptive study design was adopted. Purposive sampling was used to select 200 tribal elders from the villages of Guruwa, Pipariya, and Kasmarkhandi. Data was collected through face-to-face interviews using structured and semi-structured questionnaires. Descriptive statistics were employed for quantitative analysis, while thematic analysis was used for qualitative responses. Results: The findings revealed that 66% of respondents preferred home delivery. Cultural practices significantly influenced this preference (66%), along with a high level of trust in traditional dais (81%). Elders played a dominant role in childbirth decisions (90%). Awareness of ambulance services (82%) and the Janani Suraksha Yojana (64%) was moderate; however, only 29% were aware of a nearby delivery facility, and 61% perceived health facilities as geographically distant. Conclusion: The study concludes that the preference for home delivery is shaped by deeply rooted cultural norms, financial insecurity, limited accessibility, and trust-based relationships rather than mere personal choice. Culturally sensitive, decentralized maternal health strategies are essential to improve institutional delivery uptake in tribal regions.
Home delivery, Tribal communities, Institutional delivery, Elder decision-making, Maternal health, Bhimpur Block, Traditional birth attendants.
A Clinical Study of Socio-Demographic Variables and Their Correlation to Psychiatric Morbidities in Dermatological Disorders
Introduction: Psychological factors are increasingly recognized as important contributors to dermatological disorders. Many patients with skin diseases experience significant emotional distress, which negatively affects their quality of life and interferes with overall well-being. Symptoms such as anxiety, depression, low self-esteem, and social withdrawal are commonly reported. In addition to psychological variables, socio-demographic factors-including age, gender, marital status, educational level, and socioeconomic status may influence both the onset and prognosis of dermatological conditions. Understanding these associations is essential for guiding patient-centred and holistic management. Aim & Objective: The present study aims to evaluate socio-demographic variables and examine their correlation with psychiatric morbidities among patients with dermatological disorders. Materials & Methods: This hospital-based prospective study was conducted among patients attending the outpatient department (OPD) and inpatient ward of the Dermatology Department at B. S. Kushwah Medical College, Kanpur. Relevant socio-demographic information, along with psychiatric symptoms and diagnoses, was systematically assessed. Results: The findings demonstrate that gender, age, educational level, and socioeconomic status significantly influence the prevalence of psychiatric morbidities in dermatological patients. A statistically significant association was observed in married females, individuals aged 41–60 years, and those with education below the high-school level, who exhibited higher rates of psychiatric comorbidities compared to other groups. Conclusion: This study underscores the strong relationship between socio-demographic characteristics and psychiatric morbidities in patients with dermatological disorders. As individuals presenting to hospitals are more likely to have moderate to severe disease, these findings may not fully represent the general population of dermatology patients. Integrating psychological assessment and support into dermatological care may improve overall treatment outcomes and enhance quality of life.
Dermatological disorders, Psychiatric morbidity, Socio-demographic factors, Psychological distress, Quality of life, Mental health, Hospital-based study
Copyright (c) 2025 Journal of Recent Advances in Applied Sciences (pISSN 0970-1990)
Clinical & Ultrasonography Based Scoring to Predict Pre-Operatively the Conversionof Laparoscopic to Open Cholecystectomy - A Prospective Observational Study
Introduction: Laparoscopic cholecystectomy (LC) is the standard procedure for gallbladder removal due to its minimally invasive nature and better postoperative outcomes. However, conversion to open cholecystectomy (OC) may be required in certain high-risk cases, leading to longer operative times and increased morbidity. Early identification of factors predictive of conversion is essential to improve surgical preparedness and patient counseling. Materials & Methods: This prospective observational study was conducted at the Department of General Surgery, J.A. Group of Hospitals, Gwalior, over 18 months. A total of 330 patients diagnosed with cholelithiasis and planned for LC were evaluated preoperatively using a clinical and ultrasonographic scoring system. Parameters included gallbladder morphology, wall thickness, stone size and location, number of attacks, duration of complaints, and comorbidities. Standard laparoscopic cholecystectomy was performed, and intraoperative conversion rates were recorded. Statistical analysis was done using SPSS-25, with ROC curve analysis used to identify predictive cutoff scores. Results: Out of 330 patients, 38 (11.5%) required conversion to OC. The conversion rate was significantly higher in patients aged 51–60 years (29.6%), those with multiple prior attacks (up to 83.3%), and those with complaints longer than 12 months (60.5%). Ultrasonographic factors such as gallbladder wall thickness >3 mm, stone at the neck, stone size ≥2 cm, and pericholecystic collection were significantly associated with conversion. A USG score cutoff of >8.5 predicted conversion with moderate sensitivity and specificity. Conclusion: Clinical and ultrasonographic parameters effectively predict the likelihood of conversion from LC to OC. The scoring system aids in risk stratification, surgical planning, and informed consent, ensuring better outcomes and resource optimization.
Laparoscopic cholecystectomy, conversion, ultrasonographic scoring, gallstone disease, predictive model
Intracameral use of Moxifloxacin in Prevention of Endophthalmitis after Cataract Surgery in a Tertiary Care Centre
Introduction: Postoperative endophthalmitis is a rare but vision-threatening complication of cataract surgery. The use of intracameral antibiotics, particularly moxifloxacin, has gained attention as a preventive measure due to its broad-spectrum coverage and safety profile. Aim & Objective: To determine the incidence of postoperative endophthalmitis following cataract surgery and to evaluate the preventive efficacy of intracameral moxifloxacin. Material & Methods: This prospective observational study was conducted over 18 months in a tertiary care ophthalmology department and included 2000 patients undergoing cataract surgery by a single surgeon to ensure consistency. Patients were divided into two groups: 1000 received intracameral moxifloxacin and 1000 served as controls. Adults above 18 years providing written consent were included, while those with traumatic or complicated cataracts, combined surgeries, or intraoperative complications were excluded. Data on demographics, intraoperative events, and postoperative infection were analyzed using STATA software. Result: The overall incidence of postoperative endophthalmitis was 0.25% (5/2000 patients). Among those, one case occurred in the moxifloxacin group and four in the control group. Most patients (over 90%) had uneventful surgeries, while posterior capsule rent was observed in 7–8% of cases. Causative organisms included Streptococcus pneumoniae and Pseudomonas aeruginosa. All affected patients presented with pain, lid edema, corneal edema, and hypopyon, with visual outcomes ranging from 6/60 to no light perception. Conclusion: The study observed a low incidence of postoperative endophthalmitis consistent with global data. Although intracameral moxifloxacin did not show a statistically significant reduction in infection rates, it remains a safe adjunct. Posterior capsule rent was a key risk factor, emphasizing meticulous surgical technique and infection control.
Cataract surgery, Endophthalmitis, Intracameral moxifloxacin, Posterior capsule rent, Prophylaxis
Study of Serum Electrolytes in Patients Presenting with Acute Exacerbation of Chronic Obstructive Pulmonary Disease
Introduction: Electrolyte imbalances, particularly hyponatremia and hypokalemia, are common in acute exacerbation of COPD (AECOPD) and may worsen outcomes. Aim & Objective: To assess the prevalence and impact of serum electrolyte imbalances, specifically hyponatremia and hypokalemia, in patients with AECOPD. Materials & Methods: A prospective observational study included 113 AECOPD patients admitted to G.R. Medical College, Gwalior (May 2023–Sept 2024). Serum sodium and potassium were measured at admission and discharge. Clinical severity was assessed using mMRC and qSOFA scores, and associations with smoking status, ECG findings, recovery, hospital stay, and mortality were analyzed. Results: Most patients were male (79.6%), smokers (61.9%), and aged >70 years (45.1%). Hyponatremia and hypokalemia were observed in 55.8% and 43.4%, respectively, and were significantly associated with smoking. Lower electrolyte levels correlated with higher mMRC and qSOFA scores (p<0.05). Patients with electrolyte imbalances had delayed recovery, prolonged hospitalization, and higher mortality, with the worst outcomes in those with both imbalances. ECG changes, including sinus tachycardia and pulmonale, were more frequent in patients with these disturbances. Conclusion: Hyponatremia and hypokalemia are prevalent in AECOPD and linked to increased disease severity, longer hospital stay, and higher mortality. Early detection and correction of these imbalances are crucial to improve outcomes.
Acute exacerbation of COPD, hyponatremia, hypokalemia, serum electrolytes, mMRC, qSOFA, hospital outcomes, electrolyte imbalance
Unmasking the Hidden Uterine Cavity: Laparoscopic Excision of ACUM in an Adolescent Girl
Introduction: Accessory Cavitated Uterine Malformation (ACUM) is a rare congenital Müllerian anomaly characterized by a non-communicating accessory uterine cavity lined with functional endometrial tissue. It is usually located near the uterine cornua and presents in young, nulliparous women with severe dysmenorrhea and chronic pelvic pain. Due to its rarity and overlapping features with other gynecological disorders, ACUM is often misdiagnosed, delaying appropriate management. Case Presentation: An 18-year-old nulliparous female presented with severe, cyclical lower abdominal pain and dysmenorrhea persisting for three years, unresponsive to conventional medical therapy. Pelvic ultrasonography and magnetic resonance imaging revealed a well-defined intramyometrial cystic lesion near the right uterine horn, not communicating with the endometrial cavity, suggestive of ACUM. Laparoscopic evaluation confirmed the diagnosis, and the lesion was excised completely. Postoperative recovery was uneventful, and the patient reported complete resolution of dysmenorrhea during follow-up. Discussion: ACUM results from a developmental anomaly involving the Müllerian ducts, leading to the formation of an accessory uterine cavity with functional endometrium. The condition mimics endometriosis, adenomyosis, or uterine fibroids on imaging. MRI serves as the diagnostic modality of choice due to its superior soft-tissue characterization. Surgical excision of the accessory cavity is curative and provides long-term symptom relief, preserving fertility. Conclusion: ACUM, though rare, should be considered in young women presenting with refractory dysmenorrhea or chronic pelvic pain. Early recognition and laparoscopic excision result in excellent symptom resolution and improved quality of life.
ACUM, Dysmenorrhea, Müllerian anomalies, Laparoscopy, Uterine malformation
Robotic-Assisted Myomectomy of a Deeply Impacted Retroperitoneal Fibroid Running Head: Robotic Myomectomy of Retroperitoneal Fibroid
Background: Retroperitoneal fibroids are rare benign smooth muscle tumors accounting for approximately 1.2% of all uterine leiomyomas. Their atypical extrauterine location often leads to diagnostic uncertainty and may mimic pelvic malignancies. Minimally invasive and robotic-assisted surgical approaches have recently expanded therapeutic options for such complex cases. Case Presentation: A 49-year-old multiparous woman presented with heavy menstrual bleeding and dull pelvic pain for one year. Clinical examination revealed a firm, immobile mass in the rectovaginal septum. MRI identified a 7×6×5 cm retroperitoneal fibroid with degenerative changes compressing the rectum, along with two smaller uterine fibroids. Tumor markers were normal. The patient underwent robotic-assisted hysterectomy with concomitant myomectomy using the da Vinci Xi system. The retroperitoneal fibroid was safely dissected and delivered vaginally without intraoperative complications. Result: Postoperative recovery was uneventful, and the patient was discharged after 48 hours. Histopathology confirmed benign leiomyoma. At one-month follow-up, she remained asymptomatic. Conclusion: Robotic-assisted surgery provides enhanced visualization and precision, enabling safe removal of deeply impacted retroperitoneal fibroids with minimal morbidity. This case highlights the safety and efficacy of robotic-assisted management in complex gynecologic surgery.
Robotic, Myomectomy, Retroperitoneal fibroid Leiomyoma Robotic surgery
Clinical Profile, Management, and Outcomes of Penile Fracture: A Case Series of Four Patients
Background: Penile fracture is an uncommon urological emergency that requires prompt surgical management to prevent long-term complications such as erectile dysfunction and penile curvature. Material & Methods: We present a case series of four patients with penile fracture managed surgically at our institution. Patient demographics, clinical presentation, operative findings, surgical methods, and outcomes were analyzed. Results: The mean age was 45.7 years (range: 35–58). The duration from injury to presentation varied between 6 and 48 hours. Sexual intercourse was the most common cause (three cases, 75%), with one case resulting from accidental fall on an erect penis. All patients presented with penile pain, swelling, and immediate detumescence; two reported an audible 'snap'. Intraoperative findings revealed tunical tears in the right corpora cavernosa (n=2), left corpora cavernosa (n=1), and bilateral corpora cavernosa (n=1). Surgical repair was performed using subcoronal degloving in three patients and direct incision in one. No urethral injuries were noted. Postoperatively, one patient developed wound infection, managed conservatively. At follow-up, three patients had normal erectile function, while one developed mild penile curvature with preserved functional erections. Conclusion: Early surgical repair of penile fracture results in favorable outcomes. Our series reinforces the importance of prompt diagnosis and intervention to preserve sexual function.
Penile Fracture Surgical repair Erectile Dysfunction Corpora Cavernosa Urological emergency
A Clinical Study of Treatment Outcomes in Patients with Liver Abscess in a Tertiary Care Hospital
Introduction: This study investigated treatment outcomes in 200 patients with liver abscesses over 1.5 years at a tertiary care hospital. Materials & Methods: Patient demographics, clinical presentations, treatment methods, and outcomes such as abscess resolution, complications, and hospital stay duration were examined. Results: Results revealed that antibiotic therapy alone was successful in 72% of cases, particularly for abscesses smaller than 5 cm and in patients who were hemodynamically stable. Percutaneous drainage was employed in 20% of patients, demonstrating a high success rate with minimal complications, and was most effective for abscesses that were not amenable to antibiotic treatment alone. Surgical intervention was required in 8% of cases, especially for large or multi-loculated abscesses, or those with complications like rupture or sepsis, resulting in longer hospital stays and a higher complication rate compared to less invasive treatments. Factors influencing outcomes included abscess size, patient comorbidities, and initial response to antibiotics. Conclusion: The study underscores the significance of early diagnosis and individualized treatment plans in achieving favorable outcomes for patients with liver abscesses. A multidisciplinary approach is recommended for managing complex cases to optimize patient outcomes and minimize complications. The study suggests the need for further prospective research to refine treatment strategies and improve patient care in liver abscess management.
Liver Abscess Treatment Outcomes Antibiotic Therapy Percutaneous Drainage Surgical Intervention Tertiary Care Hospital