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 41) 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
Langerhans Cell Histiocytosis Presenting Primarily as Cervical Lymphadenopathy: A Diagnostic Challenge in Tuberculosis-Endemic Regions
Introduction: Langerhans Cell Histiocytosis (LCH) is an uncommon clonal proliferative disorder of antigen-presenting dendritic cells, predominantly affecting children. It presents with a wide clinical spectrum, ranging from localized bone or skin involvement to disseminated multisystem disease. Cervical lymphadenopathy is unusual and often mimics infectious or lymphoproliferative conditions, making diagnosis challenging. Aim & Objective: To highlight an unusual presentation of LCH as bilateral cervical lymphadenopathy with skull lesions, and to emphasize the diagnostic utility of fine needle aspiration cytology (FNAC) with cell block immunohistochemistry in distinguishing it from mimickers. Case Presentation: A one-and-a-half-year-old girl presented with bilateral cervical lymphadenopathy and intermittent fever for four months. Clinical and radiological evaluation was performed. FNAC from cervical lymph nodes with cell block preparation and immunohistochemistry was undertaken. Results: Cytological smears showed numerous atypical histiocytes with vesicular nuclei, nuclear grooves, and abundant pale cytoplasm, accompanied by eosinophils, lymphocytes, and multinucleated giant cells. Immunohistochemistry revealed positivity for S100 and CD68, supporting the diagnosis of LCH. Radiological imaging demonstrated lytic lesions in the frontal and parietal skull bones. Based on cytomorphology, immunohistochemistry, and radiological correlation, a final diagnosis of LCH was made. Conclusion: This case highlights the diagnostic challenge posed by LCH with unusual lymph node involvement. Its clinical resemblance to tuberculosis, lymphoma, or Rosai-Dorfman disease often leads to misdiagnosis. FNAC, aided by immunohistochemistry, plays a pivotal role in early recognition. Early diagnosis is crucial as clinical behavior ranges from self-limiting lesions to aggressive multisystem disease requiring chemotherapy. Awareness of atypical presentations prevents diagnostic delays and improves patient outcomes.
Langerhans cell histiocytosis, Cervical lymphadenopathy, Fine needle aspiration cytology, Immunohistochemistry, Diagnostic challenge, Pediatric pathology
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Systemic Sclerosis Presenting with Distal Renal Tubular Acidosis, Severe Hypokalemia, & Interstitial Lung Disease: A Rare Multisystem Presentation
Introduction: Systemic sclerosis (SSc) is a multisystem autoimmune connective tissue disorder characterized by fibrosis, vasculopathy, and immune dysregulation. Distal renal tubular acidosis (dRTA) is an uncommon manifestation and may rarely present with life-threatening electrolyte abnormalities. Aim & Objectives: To report a rare case of systemic sclerosis–Sjögren overlap syndrome presenting with distal renal tubular acidosis and severe hypokalemia. To highlight the importance of early recognition of autoimmune causes of unexplained metabolic acidosis and the role of prompt diagnosis and appropriate immunosuppressive management in improving clinical outcomes. Case Presentation: A 58-year-old woman with a history of type 2 diabetes mellitus and hypothyroidism presented with acute respiratory distress, hypoxia, hypotension, and generalized limb weakness. She required intensive care unit admission and ventilatory support. Initial investigations revealed severe hypokalemia and metabolic acidosis. Further evaluation demonstrated a positive urine anion gap consistent with distal renal tubular acidosis. Autoimmune workup showed positivity for antinuclear antibodies, anti-Scl-70, anti-SSA, and Ro-52 antibodies. Skin biopsy confirmed systemic sclerosis with Sjögren overlap syndrome. Additional investigations revealed interstitial lung disease with a nonspecific interstitial pneumonia pattern, esophageal dysmotility, vocal cord paralysis, and proteinuria, indicating extensive multisystem involvement. The patient was treated with correction of electrolyte abnormalities, corticosteroids, immunosuppressive therapy, and supportive care. Significant clinical improvement was observed with normalization of serum potassium levels and recovery from respiratory and hemodynamic compromise. Results: A 58-year-old woman with systemic sclerosis–Sjögren overlap syndrome presented with distal renal tubular acidosis, severe hypokalemia, and metabolic acidosis causing respiratory failure and hypotension. Treatment with electrolyte correction, corticosteroids, immunosuppressants, and supportive care resulted in normalization of serum potassium, resolution of acidosis, and significant clinical recovery. Conclusion: This case highlights a rare presentation of systemic sclerosis with Sjögren overlap syndrome manifesting as distal renal tubular acidosis and severe hypokalemia. Early recognition of autoimmune causes of unexplained metabolic acidosis and hypokalemia is essential for timely diagnosis and appropriate management.
Systemic sclerosis; Sjögren syndrome; Distal renal tubular acidosis; Hypokalemia; Interstitial lung disease; Autoimmune disease.
Erdheim-Chester Disease Presenting as Refractory Anemia: A Rare Case Report from Central India
Introduction: Erdheim–Chester disease (ECD) is a rare non-Langerhans cell histiocytosis characterized by multisystem infiltration of foamy histiocytes and progressive fibrosis. Owing to its heterogeneous clinical presentation and rarity, diagnosis is often delayed and requires histopathological and immunohistochemical confirmation. Aim & Objectives: To report a rare case of Erdheim–Chester disease presenting with refractory anemia, highlighting the role of bone marrow biopsy and immunohistochemistry in diagnosis, and emphasizing the importance of early molecular evaluation for targeted therapy and improved patient outcomes. Case Presentation: A 47-year-old female presented with generalized weakness, easy fatigability, intermittent diarrhea, insomnia, and refractory anemia. Routine laboratory and radiological investigations were inconclusive. Peripheral smear revealed normocytic normochromic anemia. Bone marrow aspiration was inadequate due to fibrosis, following which a trephine biopsy was performed. Histopathological examination showed diffuse infiltration by spindle-shaped and foamy histiocytes associated with stromal fibrosis. Immunohistochemistry demonstrated positivity for CD68 and CD163, while CD1a and Langerin (CD207) were negative, excluding Langerhans cell histiocytosis. CD3 highlighted admixed reactive T-lymphocytes. Based on histomorphological and immunophenotypic findings, a diagnosis of Erdheim–Chester disease was established. The patient received supportive treatment and was advised molecular testing for BRAF mutation analysis and further systemic evaluation for targeted therapy planning. Results: Bone marrow biopsy with immunohistochemistry confirmed Erdheim–Chester disease, showing CD68 and CD163 positivity with negative CD1a and CD207. The patient received supportive treatment and was advised BRAF mutation analysis for targeted therapy. Conclusion: This case highlights the importance of considering Erdheim–Chester disease in patients presenting with unexplained constitutional symptoms and infiltrative marrow pathology. Bone marrow biopsy with immunohistochemistry plays a pivotal role in diagnosis. Early recognition and molecular evaluation are essential for timely initiation of targeted therapy and improved clinical outcomes.
Erdheim-Chester disease; Non-Langerhans histiocytosis; Bone marrow biopsy; Immunohistochemistry; CD68; BRAF mutation
Comparison between Laparoscopic Surgeries & Lichtenstein Repair for the Treatment of Inguinal Hernias
Introduction: Inguinal hernia repair is one of the most performed surgeries worldwide. While Lichtenstein tension-free mesh repair remains the standard open technique, laparoscopic approaches such as TAPP and TEP are increasingly favored due to improved postoperative recovery and patient comfort. Aim & Objectives: To compare laparoscopic repair and Lichtenstein repair for the treatment of inguinal hernias with respect to operative outcomes, postoperative pain, complications, recovery parameters, patient satisfaction, and cost. Materials & Methods: This prospective comparative study included 100 patients with inguinal hernia, equally divided into laparoscopic (n=50) and Lichtenstein repair (n=50) groups. Outcomes assessed included operative time, complications, postoperative pain, hospital stay, return to work, patient satisfaction, and treatment cost. Statistical significance was set at p<0.05. Results: Baseline demographic characteristics were comparable between the groups. Operative time was significantly longer in the laparoscopic group (72.58±8.18 vs. 56.12±6.11 minutes; p<0.001). However, laparoscopic repair was associated with significantly lower pain scores at 24 hours, 72 hours, and 3 months (p<0.05). Hospital stay (2.12±0.48 vs. 3.63±0.70 days; p<0.001) and time to return to work (9.16±2.53 vs. 14.88±3.06 days; p<0.001) were significantly shorter following laparoscopic repair. Wound infection rates were lower (6.0% vs. 24.0%; p=0.011), while hematoma formation was slightly higher (16.0% vs. 4.0%; p=0.046). Patient satisfaction was significantly greater in the laparoscopic group (p<0.001). The mean surgical cost was higher for laparoscopic repair (₹25,149.74±2,505.40 vs. ₹4,534.30±3,418.32; p<0.001). Conclusion: Laparoscopic inguinal hernia repair offers less postoperative pain, faster recovery, a shorter hospital stay, lower wound infection rates, and greater patient satisfaction than Lichtenstein repair, though it involves a longer operative time and a higher cost.
Inguinal hernia; Laparoscopic repair; Lichtenstein repair; TAPP; TEP; Mesh hernioplasty; Postoperative pain; Patient satisfaction.
Fracture Resistance of MOD Cavities Restored with Short Fibre, Long Fibre, & Ribbond Reinforcements: An in-vitro Comparative Study
Introduction: Mesio-occluso-distal (MOD) cavity preparations significantly weaken posterior teeth by reducing cuspal stiffness and increasing susceptibility to fracture. Fibre-reinforced composite systems have been introduced to enhance the mechanical performance and longevity of restorations. Aim & Objective: To compare the fracture resistance and failure patterns of MOD cavities restored with short fibre composite, long fibre reinforcement, and Ribbond reinforcement with those restored using conventional composite resin. Materials & Methods: Forty extracted human molars with standardized MOD cavity preparations were randomly allocated into four groups (n = 10 each): Group I (conventional composite), Group II (short fibre composite), Group III (long fibre reinforcement), and Group IV (Ribbond reinforcement). Following restoration, specimens underwent compressive loading in a universal testing machine until fracture. Fracture resistance was recorded in Newtons (N), and failure modes were classified as restorable or non-restorable. Data were analyzed using one-way ANOVA and Tukey’s post-hoc test. Results: Fracture resistance differed significantly among the groups (F = 1357.26, p < 0.001). Group II showed the highest mean fracture resistance (1197.50 ± 15.14 N), followed by Group III (1037.50 ± 15.14 N), Group IV (956.30 ± 9.83 N), and Group I (787.00 ± 16.02 N). Compared with the control group, short fibre, long fibre, and Ribbond reinforcement increased fracture resistance by 52.2%, 31.8%, and 21.5%, respectively. Reinforced restorations also demonstrated a higher proportion of restorable fractures, with the short fibre group showing the most favorable failure pattern (80%). Conclusion: Fibre reinforcement significantly improves fracture resistance and promotes more favorable failure modes in MOD restorations. Short fibre composite demonstrated the best overall performance.
Fracture resistance; MOD cavity; Short fibre composite; Long fibre reinforcement; Ribbond; Fibre-reinforced composite.
Role of P63 in Premalignant & Malignant Lesions of Oral Cavity
Introduction: Oral squamous cell carcinoma (OSCC) is a major public health problem in India, largely due to tobacco, areca nut, and alcohol use. Oral potentially malignant disorders (OPMDs) can progress to OSCC, but predicting this transformation is difficult. Therefore, reliable biomarkers such as p63, which regulates epithelial proliferation and differentiation, are needed to improve diagnosis and risk assessment. Aim & Objectives: To evaluate the expression of p63 in normal oral mucosa, OPMDs, and OSCC, and to determine its diagnostic and prognostic significance by correlating its expression with histopathological grading and disease progression. Materials & Methods: This immunohistochemical study analyzed tissue samples from normal oral mucosa, OPMDs with varying grades of epithelial dysplasia, and OSCC. p63 expression was assessed based on nuclear staining pattern, labeling index, and distribution within epithelial layers. The findings were correlated with histopathological grades and relevant clinical parameters to evaluate the role of p63 in oral carcinogenesis. Results: In normal oral mucosa, p63 expression was restricted to the basal and parabasal cell layers. OPMDs exhibited increased p63 expression with extension into suprabasal layers, which correlated with the severity of epithelial dysplasia. The highest expression was observed in OSCC, showing diffuse and intense nuclear staining. A progressive increase in labeling index was noted from normal mucosa to dysplasia and carcinoma. Furthermore, elevated p63 expression was associated with poorer tumor differentiation and more aggressive biological behavior. Conclusion: p63 is a valuable immunohistochemical biomarker for evaluating epithelial dysregulation and malignant transformation in oral lesions. Its progressive overexpression from normal mucosa to OSCC supports its utility in early diagnosis, risk assessment, and prognostic evaluation, although it should be used as an adjunct to conventional histopathology.
p63, Oral squamous cell carcinoma, Oral potentially malignant disorders, Immunohistochemistry, Dysplasia
A Comparative Study of Expressed Emotions in Caregivers of Patients Suffering from Bipolar Affective Disorder, Schizophrenia & Obsessive Compulsive Disorder
Introduction: Expressed emotion (EE) is an important indicator of the caregivers’ emotional attitudes and behaviors toward patients with serious mental illnesses and has been associated with treatment outcomes, relapse, and caregiver burden. Aim & Objectives: The present study aimed to assess and compare the EE among caregivers of patients with Bipolar Affective Disorder (BAD), Schizophrenia, & obsessive-compulsive disorder (OCD), and to examine its relationship with illness severity. Material & Methods: A total of 255 caregivers were enrolled and equally distributed into three groups: caregivers of patients with BAD (n=85), schizophrenia (n=85), and OCD (n=85). Expressed emotion was assessed using the Family Attitude Scale (FAS) and Family Emotional Involvement and Criticism Scale (FEICS). Illness severity was evaluated using the YMRS, HAM-D, PANSS, and Y-BOCS scales. Data were analysed using SPSS version 25, with p≤0.05 considered statistically significant. Results: Sociodemographic characteristics of the caregivers were comparable across all groups. Caregivers of BAD patients demonstrated significantly higher FAS scores (49.40±5.20), perceived criticism, emotional involvement, and total FEICS scores compared with caregivers of schizophrenia and OCD patients (p<0.001). No significant associations were found between EE and caregiver sociodemographic variables. Correlations between illness severity and EE measures were generally weak across all diagnostic groups. Conclusion: Caregivers of patients with BAD exhibited significantly higher levels of expressed emotion than caregivers of schizophrenia and OCD patients. The findings suggest that EE is influenced more by the nature of the psychiatric illness than by caregiver sociodemographic factors. Disorder-specific psychosocial interventions aimed at reducing caregiver burden and enhancing coping skills may improve both caregiver well-being and patient outcomes.
Expressed Emotion, Caregivers, Bipolar Affective Disorder, Schizophrenia, Obsessive-Compulsive Disorder
Study on Surgical Outcomes of Choledochoduodenostomy & Roux-en-Y Hepaticojejunostomy in Cases of Intraoperative Common Bile Duct Injury - A Comparative Study
Introduction: Intraoperative common bile duct injury is a serious complication of hepatobiliary surgery and often requires definitive biliary reconstruction. Choledochoduodenostomy and Roux-en-Y hepaticojejunostomy are commonly used procedures, but their comparative postoperative outcomes remain clinically important. Aim & Objective: To compare the surgical outcomes of choledochoduodenostomy and Roux-en-Y hepaticojejunostomy in patients with intraoperative common bile duct injury, with respect to morbidity, recovery, biliary complications, and outcome. Materials & Methods: This prospective comparative study was conducted in the Department of General Surgery, S.N. Medical College, Agra, among 60 patients with intraoperative common bile duct injury. Patients were equally divided into Group A undergoing choledochoduodenostomy and Group B undergoing Roux-en-Y hepaticojejunostomy. Demographic profile, intraoperative details, ICU requirement, hospital stay, postoperative complications, biliary stricture, recurrent jaundice, readmission, mortality, satisfaction, and quality-of-life outcomes were recorded and compared. Results: Both groups were comparable for age and sex distribution. ICU requirement was significantly higher after choledochoduodenostomy than Roux-en-Y hepaticojejunostomy (6/30 vs 2/30; p=0.025). Mean hospital stay was longer in the choledochoduodenostomy group (8.80 ± 2.882 days) than the Roux-en-Y group (6.10 ± 1.882 days; p=0.016). Bile leak, wound infection, postoperative fever, pain burden, biliary stricture at 6 months (12/30 vs 5/30; p=0.015), readmission, and long-term recurrent jaundice (14/30 vs 3/30; p=0.039) were higher after choledochoduodenostomy. Final excellent outcome was more frequent after Roux-en-Y hepaticojejunostomy (18/30 vs 9/30; p=0.049). Conclusion: Roux-en-Y hepaticojejunostomy demonstrated better early recovery, fewer complications, lower stricture and recurrent jaundice rates, and superior outcome than choledochoduodenostomy, helping define the preferable reconstructive option in selected biliary injury patients.
Common bile duct injury; Choledochoduodenostomy; Roux-en-Y hepaticojejunostomy; Biliary stricture; Surgical outcome
Comparative Study of Efficacy of Letrozole with Clomiphene Citrate in Anovulatory Women with Polycystic Ovarian Syndrome
Introduction: Polycystic Ovary Syndrome (PCOS) is one of the most common endocrine disorders among women of reproductive age and a major cause of anovulatory infertility. Ovulation induction remains the cornerstone of treatment for infertile women with PCOS. Among the available pharmacological agents, Letrozole and Clomiphene Citrate are widely used, with recent evidence suggesting superior reproductive outcomes with Letrozole. Aim & Objective: To compare the efficacy and safety of Letrozole and Clomiphene Citrate for ovulation induction in women with PCOS. Materials & Methods: This comparative study was conducted at Gandhi Hospital between July 2022 and September 2023 and included 100 women diagnosed with PCOS. Participants were randomly allocated into two equal groups. The Letrozole group received 2.5 mg twice daily, while the Clomiphene Citrate group received 100 mg daily for five days starting from day 3 of the menstrual cycle. Follicular development was monitored by ultrasonography, and endometrial thickness, hormonal profile, number of mature follicles, and duration of stimulation were assessed. Results: Letrozole showed significantly better outcomes than Clomiphene Citrate. Women treated with Letrozole demonstrated a higher number of mature follicles (>14 mm and >18 mm), greater endometrial thickness, and more favorable hormonal profiles. Although the Clomiphene Citrate group developed a higher total number of follicles, follicular quality and endometrial receptivity were superior in the Letrozole group. Furthermore, Letrozole required a shorter duration of stimulation, indicating improved treatment efficiency. Conclusion: Letrozole is more effective than Clomiphene Citrate for ovulation induction in women with PCOS, providing better follicular maturation, enhanced endometrial receptivity, and improved hormonal response. These findings support Letrozole as a preferred first-line therapy for managing anovulatory infertility associated with PCOS.
Polycystic Ovary Syndrome, Letrozole, Clomiphene Citrate, Ovulation Induction, Infertility
Unusual Presentation of Uterine Rupture - A Case Series
Introduction: Uterine rupture is a catastrophic obstetric emergency defined by complete disruption of the uterine wall, including the serosa, leading to significant maternal and perinatal morbidity and mortality. While commonly associated with scarred uteri in the third trimester, atypical and unusual presentations are increasingly recognized, particularly in low-resource settings. These atypical manifestations often delay diagnosis and intervention, thereby worsening outcomes. Aim & Objectives: This study aims to highlight the spectrum of unusual presentations, associated risk factors, and clinical outcomes of uterine rupture cases managed at a tertiary care center. Material and Methods: A retrospective case series analysis was conducted in a tertiary care hospital in North Karnataka. Seven cases of uterine rupture were reviewed. Data were collected regarding demographic characteristics, obstetric history, clinical presentation, intraoperative findings, management strategies, and maternal and fetal outcomes. Cases included both scarred and unscarred uteri across different gestational ages. Results: Seven women aged 24–35 years were analyzed, including two primigravida and five multigravida with prior cesarean sections. Five ruptures occurred in the third trimester, while two occurred in the second trimester. All patients presented with acute abdominal pain; other symptoms included giddiness, vaginal bleeding, and signs of shock. Hemoperitoneum was observed in all cases. Mean hemoglobin was 6.1 g/dL. Six cases had absent fetal heart rate at presentation. Surgical management included four hysterectomies and three uterine repairs. Maternal survival was 100%, while perinatal mortality was 85.7%. Conclusion: This study underscores that uterine rupture may present atypically, including early gestation and in primigravida women. Delayed diagnosis significantly contributes to adverse fetal outcomes despite favorable maternal survival. Strengthening antenatal care, discouraging unskilled obstetric interventions, and improving early referral systems are essential to prevent such complications.
Uterine rupture; Perinatal morbidity; Hemoperitoneum; Antenatal care; Primigravida women
Diagnostic Efficacy of Triple-Phase Multidetector CT in the Evaluation of Focal Hepatic Lesions
Introduction: Focal hepatic lesions comprise a wide spectrum of benign and malignant pathologies, requiring accurate imaging-based differentiation for appropriate clinical management. Triple-phase Multidetector Computed Tomography (MDCT) plays a vital role in lesion characterization by evaluating dynamic enhancement patterns during different vascular phases. Aim & Objectives: To evaluate the diagnostic efficacy of triple-phase MDCT in the characterization and differentiation of focal hepatic lesions and to correlate imaging findings with histopathological examination. Materials & Methods: This prospective cross-sectional study was conducted over 12 months in the Department of Radiodiagnosis, Rajah Muthiah Medical College and Hospital. Fifty patients aged >20 years with suspected or ultrasonographically detected focal liver lesions underwent triple-phase MDCT. Lesions were assessed for morphology, enhancement patterns, vascular involvement, and extrahepatic features. Histopathology (FNAC, biopsy, or surgical specimens) served as the reference standard where available. Results: Among the 50 patients studied, benign lesions constituted 68% of cases, while malignant lesions accounted for 32%. Hepatic abscess was the most common benign lesion (36%), whereas metastasis was the most common malignant lesion (18%). Hemangiomas demonstrated characteristic peripheral nodular enhancement with centripetal fill-in, while hepatocellular carcinoma showed arterial hyperenhancement with portal venous washout. Triple-phase MDCT correctly characterized 43 out of 44 histopathologically correlated cases, yielding an overall diagnostic accuracy of 97.5%. Additional findings such as portal vein thrombosis, inflammatory hyperemia, and metastatic spread were effectively demonstrated. Conclusion: Triple-phase MDCT is a highly sensitive, rapid, and reliable imaging modality for evaluating focal hepatic lesions. Characteristic enhancement patterns enable accurate differentiation of benign & malignant lesions and provide essential information for diagnosis, staging, and treatment planning.
Triple-phase MDCT; Focal hepatic lesions; Hepatocellular carcinoma; Hepatic hemangioma; Liver metastasis; Contrast-enhanced CT; Hepatic imaging.
Role of International Endometrial Tumor Analysis (IETA) Ultrasound Criteria vs Endometrial Thickness in Evaluation of Post Menopausal Bleeding
Introduction: Postmenopausal bleeding is a significant clinical condition requiring prompt evaluation to exclude endometrial malignancy. Endometrial cancer is among the most common gynecological cancers, and early detection is crucial for improving prognosis. Conventional assessment using endometrial thickness lacks specificity, prompting the need for more comprehensive approaches. The International Endometrial Tumor Analysis criteria provide a standardized, multiparametric ultrasound-based evaluation. Aim & Objective: This study aimed to compare the diagnostic efficacy of IETA criteria with endometrial thickness using histopathology as the gold standard. Material & Methods: A prospective observational study was conducted over 18 months at a tertiary care center, including 62 postmenopausal women presenting with bleeding per vaginum. All participants underwent detailed clinical assessment, transvaginal ultrasonography evaluating endometrial thickness and IETA parameters, followed by histopathological examination through biopsy or hysterectomy. IETA assessment included echogenicity, endo-myometrial junction, midline appearance, intracavitary fluid, and Doppler vascularity. Diagnostic performance was analyzed using sensitivity, specificity, predictive values, and accuracy. Results: Among 62 patients, 11 cases were confirmed as endometrial carcinoma. IETA demonstrated higher sensitivity (83.68%) and specificity (39.22%) compared to endometrial thickness (81.82% and 18%, respectively). The overall diagnostic accuracy was greater with IETA (47.6%) than with endometrial thickness (30%). IETA also showed a high negative predictive value (90.92%), indicating reliability in ruling out malignancy. Ultrasound features such as heterogeneous echotexture, irregular endo-myometrial junction, and increased vascularity showed a strong association with malignancy. Conclusion: IETA criteria outperform endometrial thickness alone in evaluating postmenopausal bleeding by providing improved sensitivity and diagnostic accuracy. However, both methods have limited specificity and should not be used independently. A combined approach incorporating IETA with histopathological correlation enhances diagnostic reliability and aids in appropriate clinical decision-making.
Postmenopausal bleeding, IETA, Endometrial thickness, Transvaginal ultrasonography, Endometrial carcinoma
Functional & Radiological Outcomes of Suprapatellar Intramedullary Nailing in Proximal Tibial & Tibial Shaft Fractures: A Prospective Study
Introduction: Proximal tibial and tibial shaft fractures are common injuries often caused by high-energy trauma. Conventional infrapatellar intramedullary nailing with the knee in flexion may lead to difficulty in maintaining alignment, whereas the suprapatellar semi-extended approach improves fracture reduction, alignment control, and surgical ergonomics. Aim & Objectives: To evaluate the effectiveness of suprapatellar intramedullary nailing in proximal tibial and tibial shaft fractures by assessing fracture reduction, alignment, functional and radiological outcomes, and postoperative complications associated with the suprapatellar approach. Materials & Methods: A prospective observational study was conducted on 30 patients with proximal tibial and tibial shaft fractures treated with suprapatellar intramedullary nailing at Kanti Devi Medical College Hospital & Research Centre. Patients were followed for six months with clinical and radiological evaluation. Functional outcomes were assessed using the Lysholm Knee Scoring Scale and LEFS, while arthroscopy was used to evaluate patellofemoral cartilage integrity before and after nail insertion. Results: The mean age of patients was 48.2 ± 18.6 years. Radiological union was achieved within 16 weeks in 86.6% of patients, with a mean union time of 13.8 ± 2.7 weeks. Knee flexion greater than 120° was achieved in 66.7% of patients. The mean Lysholm score was 82.6 ± 11.4 and the mean LEFS score was 69.2 ± 12.1. Anterior knee pain was observed in 6.6% of patients. Arthroscopic evaluation demonstrated minimal patellofemoral cartilage injury in most cases. Conclusions: Suprapatellar intramedullary nailing is a safe and effective technique for proximal tibial and tibial shaft fractures. The semi-extended position facilitates improved fracture alignment and provides satisfactory fracture union with good functional outcomes and minimal complications.
Suprapatellar nailing, Proximal Tibial fracture, Tibial shaft fracture, Intramedullary nail, Lysholm score, LEFS
Histopathological Spectrum of Cutaneous Adnexal Tumours: A Tertiary Care Centre Experience
Introduction: Cutaneous adnexal tumors (CATs) are a diverse group of neoplasms originating from the adnexal structures of the skin, including hair follicles, sebaceous glands, eccrine glands, and apocrine glands. These tumors demonstrate varied histopathological differentiation and clinical presentations, ranging from benign lesions to rare malignant counterparts. Accurate diagnosis and classification are essential because of their diverse biological behavior and potential association with syndromic conditions. Aim & Objectives: To evaluate the clinicopathological spectrum of cutaneous adnexal tumors with respect to age, sex, anatomical site, histological differentiation, and tumor type. Materials & Methods: This retrospective descriptive study included 48 histopathologically confirmed cases of cutaneous adnexal tumors. Clinical details were retrieved from medical records. Formalin-fixed, paraffin-embedded tissue sections were stained with hematoxylin and eosin and examined microscopically. Tumors were categorized according to their line of differentiation. Statistical analysis was performed using descriptive statistics and the Chi-square test, with p < 0.05 considered statistically significant. Results: Most cases occurred in the 21–40 years age group, with a slight male predominance. The head and neck region were the most affected site (64.6%). Follicular differentiation was the predominant histological type (64.6%), followed by eccrine and apocrine differentiation. Trichilemmal cyst was the most common diagnosis, accounting for 37.5% of cases. A statistically significant association was observed between anatomical site and differentiation pattern (p < 0.05). Most tumors were benign in nature. Conclusion: Cutaneous adnexal tumors are predominantly benign lesions with a strong predilection for the head and neck region and follicular differentiation. Histopathological examination remains the cornerstone for accurate diagnosis and classification of these tumors.
Cutaneous adnexal tumors; Histopathology; Follicular differentiation; Trichilemmal cyst; Skin neoplasms; Clinicopathological study
A Clinical Study of Placenta Previa & its Effect on Maternal & Fetal Outcome
Introduction: Placenta previa is a major obstetric complication in which the placenta is implanted in the lower uterine segment, partially or completely covering the internal cervical os, leading to antepartum hemorrhage, operative delivery, and increased maternal and neonatal morbidity. Its incidence has gained importance with rising cesarean section rates and improved ultrasonographic diagnosis. Aim & Objective: To study the prevalence of placenta previa, evaluate maternal and fetal outcomes, and identify associated risk factors. Materials & Methods: This hospital-based observational study was conducted in the Department of Obstetrics and Gynaecology, MCH, KIMS Koppal, from June 2024 to May 2025. Pregnant women diagnosed with placenta previa after 28 weeks of gestation, either clinically or by ultrasonography, were included. Detailed history, clinical examination, investigations, intraoperative findings, maternal complications, and neonatal outcomes were recorded and analyzed. Results: A total of 38 cases were studied. Most women were aged 31 to 35 years (47.0%) and multiparous, with para 2 to 4 constituting 65.7%. Previous cesarean section was present in 75.0% cases. Cesarean delivery was performed in 78.94%. Maternal morbidity included blood transfusion (47.3%), uterine artery ligation (26.3%), postpartum hemorrhage (21.05%), ICU admission (7.89%), and cesarean hysterectomy (5.26%), with no maternal mortality. Neonatal outcomes showed birth weight ≥2.5 kg in 70.0%, APGAR score ≥6 in 72.0%, NICU admission in 28.9%, and perinatal death in 10.05%. Advanced maternal age and multiparity were prominent associated factors. Conclusion: Placenta previa remains a significant cause of maternal and perinatal morbidity. Early diagnosis, timely referral, blood bank preparedness, and multidisciplinary management are essential for improving fetomaternal outcome and reducing preventable complications in high-risk pregnancies managed at tertiary care centres overall.
Placenta previa; Antepartum hemorrhage; Cesarean section; Maternal outcome; Fetal outcome
Functional Outcome of Coronoid Process Fracture Fixed with Suture Anchors
Introduction: Coronoid process fractures are a key determinant of elbow stability, especially in terrible triad injuries, where disruption of the anterior buttress leads to instability and functional impairment. Suture anchor fixation has gained importance in managing small and comminuted fragments by restoring capsuloligamentous integrity and enabling early mobilization. Aim & Objective: To evaluate the functional outcome of coronoid process fractures fixed with suture anchors, with specific assessment of elbow stability, range of motion, HSS elbow score, and postoperative complications. Materials & Methods: This observational follow-up study was conducted in the Department of Orthopaedics, Government Medical College, Kottayam, over 16 months after IRB approval. A total of 21 adult patients with terrible triad elbow and Regan Morrey type I and II coronoid fractures were included. All patients underwent coronoid fixation using suture anchors along with appropriate management of radial head fractures and lateral collateral ligament repair. Postoperative immobilization was maintained for two weeks, followed by structured rehabilitation. Patients were followed for six months and evaluated using the HSS elbow score. Results: The mean flexion arc was 107°, the mean flexion contracture was 14°, and the mean rotational arc was 131°, indicating satisfactory restoration of motion. The majority of patients achieved functional forearm rotation, and 53% had minimal contracture (≤10°). HSS scoring showed 14% excellent, 62% good, 9.5% fair, 9.5% poor, and 4.8% failed outcomes, reflecting predominantly favorable recovery. Conclusion: Suture anchor fixation of Regan Morrey type I and II coronoid fractures provide stable fixation, facilitates early mobilization, and results in good to excellent functional outcomes, supporting its effectiveness as a minimally invasive technique.
Coronoid process fracture; Suture anchor fixation; Terrible triad elbow; HSS elbow score; Functional outcome
Hospital-Based Study to Assess One-Year Follow-Up of Efficacy in Patients of Varicose Vein Treated with 1470 Endovenous Diode Laser Ablation
Introduction: Varicose veins are a common manifestation of chronic venous disease and result from valvular incompetence and venous reflux, leading to pain, heaviness, edema, skin changes, and reduced quality of life. Endovenous laser ablation has emerged as a minimally invasive alternative to conventional surgery because it offers less postoperative morbidity, shorter recovery, and better patient acceptance. The 1470 nm diode laser, with greater absorption by water in the vein wall, is expected to produce more effective and uniform ablation with fewer complications. Aim & Objective: To assess the one-year efficacy of 1470 nm endovenous diode laser ablation in patients with varicose veins using duplex ultrasound, and to evaluate symptom improvement, recurrence, procedural parameters, post-treatment complications, and patient-reported outcomes. Materials & Methods: This prospective observational study was conducted at G.R. Medical College and J.A. Group of Hospitals, Gwalior, from April 2024 to September 2025 in 94 adults with primary symptomatic varicose veins (CEAP C2 to C6). All underwent 1470 nm endovenous diode laser ablation and completed a one-year follow-up for assessment of clinical profile, duplex findings, procedural details, complications, recurrence, and Venous Clinical Severity Score. Results: Complete occlusion at 12 months was achieved in 94.68% cases, while recurrence occurred in 5.3%. Radial fiber showed significantly lower recurrence than bare fiber (p = 0.012). Mean VCSS improved from 8.11 ± 3.02 before treatment to 2.55 ± 3.17 in 12 months (p < 0.001). Complications were minor and included ecchymosis, transient paresthesia, and thrombophlebitis. Conclusion: 1470 nm endovenous diode laser ablation is a safe, effective, and minimally invasive treatment for varicose veins with excellent one-year outcomes.
Varicose veins; Endovenous laser ablation; 1470 nm diode laser; Recurrence; VCSS
A Retrospective Study of Pregnancy Outcome with Uterine Fibroids - A Case Series
Introduction: Uterine fibroids are the commonest benign uterine tumors in women of reproductive age and are increasingly encountered during pregnancy. Their presence may alter placentation, fetal lie, labor progress, and postpartum uterine contractility, thereby contributing to adverse maternal and perinatal outcomes. However, the clinical course varies according to fibroid size, number, and location. Aim & Objective: To evaluate pregnancy outcomes in women with uterine fibroids and to assess associated maternal, fetal, intrapartum, postpartum, and perinatal complications in fibroid-complicated pregnancies. Materials & Methods: This retrospective case series was conducted at a tertiary care centre, KIMS, Koppal, and included 9 pregnant women with uterine fibroids managed between January 2025 and June 2025. Data were collected from hospital case records and labor ward registers. Variables studied included maternal age, gravidity, conception type, abortion history, timing of fibroid diagnosis, fibroid size, site and number, indication for cesarean section, maternal and postpartum complications, birth weight, and NICU admission. Descriptive analysis was performed. Results: Maternal age ranged from 24 to 34 years, with all women being multigravida. Conception was spontaneous in 7 cases and induced in 2. Fibroids were diagnosed antenatally in 6 cases, before conception in 2, and intraoperatively in 1. Sizes ranged from 3 to 12 cm, mostly single and subserosal. All patients underwent cesarean section. Complications included APH, hypertensive disorders, preterm labor, and malpresentation. Postpartum hemorrhage occurred in 4 cases, 7 required transfusion, and 3 neonates needed NICU admission. Conclusion: Pregnancy with uterine fibroids was associated with considerable fetomaternal morbidity, particularly operative delivery, hemorrhagic complications, and selective adverse neonatal outcomes. Early diagnosis, close antenatal surveillance, and careful delivery planning are essential to improve outcomes.
Uterine fibroids; Pregnancy outcome; Cesarean section; Postpartum hemorrhage; NICU admission
From Silent Retention to Pelvic Sepsis: Vaginoscopic Removal of a Vaginal Foreign Body followed by Laparoscopic Drainage of Tubo Ovarian Abscess in a 13 Year Old
Introduction: Vaginal foreign bodies are uncommon in adolescents and often present with nonspecific or absent genital symptoms, leading to delayed diagnosis. Common manifestations include vaginal discharge, bleeding, recurrent infection, or pelvic pain, although some patients may remain asymptomatic. Prolonged retention may result in chronic inflammation, adhesions, pelvic inflammatory disease, and tubo-ovarian abscess formation. Early imaging and vaginoscopic evaluation are essential for timely diagnosis and prevention of complications. Aim & Objective: To highlight an unusual presentation of a vaginal foreign body in an adolescent girl without genital symptoms and to emphasize the importance of imaging and multidisciplinary management in preventing complications. Case Presentation: A 13-year-old premenarchal girl presented with intermittent lower abdominal pain, fever, and vomiting for two weeks without vaginal complaints. Ultrasonography suggested bilateral adnexal masses with right hydrosalpinx and a possible vaginal foreign body. Contrast-enhanced MRI revealed bilateral tubo-ovarian abscesses with a suspected vaginal foreign body. Psychiatric and forensic evaluations were performed due to medicolegal concerns. Diagnostic vaginoscopy under general anaesthesia identified a cylindrical plastic lipstick cap measuring 3 × 2 cm lodged transversely in the upper vagina with adhesions and pus collection. Result: The foreign body was successfully removed under vaginoscopic guidance with minimal trauma, followed by laparoscopic drainage of bilateral tubo-ovarian abscesses. The patient recovered without complications following multidisciplinary management. Conclusion: Vaginal foreign bodies should be considered in adolescents presenting with unexplained abdominal or pelvic symptoms, even in the absence of genital complaints. Early imaging, prompt diagnosis, and multidisciplinary evaluation are essential to avoid delayed treatment and serious complications.
Vaginal foreign body, Adolescent lower abdominal pain, Paediatric gynaecology, Case report
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
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.