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
Parotid Swelling Unmasked: Tuberculosis Masquerading as Pleomorphic Adenoma
Introduction: Tuberculosis involving the parotid gland is an exceedingly rare manifestation, representing less than 0.1% of all tubercular infections. Its clinical and radiological resemblance to benign parotid tumors, especially pleomorphic adenoma, often leads to diagnostic confusion and unnecessary surgical interventions. Aims & Objectives: This case report aims to describe an unusual presentation of parotid tuberculosis initially misdiagnosed as pleomorphic adenoma, to highlight the diagnostic utility of fine-needle aspiration cytology (FNAC) and Ziehl–Neelsen staining, and to emphasize the importance of clinical suspicion in endemic regions. Case Presentation: A 62-year-old male presented with a slow-growing, painless swelling in the right parotid region of several months’ duration, associated with intermittent low-grade fever. Clinical examination revealed a firm, ill-defined swelling below the pinna. Ultrasonography showed a heterogeneous lobulated lesion in the superficial lobe of the parotid, raising suspicion of pleomorphic adenoma. FNAC and Ziehl–Neelsen staining were performed to establish the diagnosis. Results: Cytological examination revealed epithelioid cell granulomas, lymphohistiocytic clusters, and necrosis. Ziehl–Neelsen staining demonstrated acid-fast bacilli with 3+ positivity, confirming the diagnosis of parotid tuberculosis. The patient was started on standard anti-tubercular therapy (ATT) as per national guidelines. Remarkable clinical improvement with significant regression of the swelling was observed within weeks of therapy, avoiding unnecessary surgical excision. Conclusion: Parotid tuberculosis, though rare, should be considered as a differential diagnosis in patients presenting with parotid swelling, especially in tuberculosis-endemic regions. Its clinical and imaging resemblance to pleomorphic adenoma makes diagnosis challenging. FNAC combined with AFB staining remains the cornerstone for diagnosis, allowing prompt initiation of medical management and preventing unwarranted surgical interventions. A high index of suspicion, supported by cytopathological evidence, is essential for timely recognition and treatment. REFERENCES: Rodriguez-Takeuchi SY, Renjifo ME, Medina FJ. Extrapulmonary tuberculosis: pathophysiology and imaging findings. Radiographics. 2019;39(7):2023-2037. https://doi.org/10.1148/rg.2019190109 Popescu MR, Pleşea IE, Olaru M, Strâmbu IR, Fronie AI, Petrescu IO, et al. Morphological aspects in tuberculosis of the oral cavity: our experience and an attempt to review the literature. Rom J Morphol Embryol. 2015;56(3):967-987. Rocha EL, Pedrassa BC, Bormann RL, Kierszenbaum ML, Torres LR, D'Ippolito G. Abdominal tuberculosis: a radiological review with emphasis on computed tomography and magnetic resonance imaging findings. Radiol Bras. 2015;48(3):181-191. https://doi.org/10.1590/0100-3984.2013.1801 Hu SS, Wei QC, Wu Y, Li XN, Liu FJ, Wang B. Treatment course of cavitary pulmonary tuberculosis combined with tuberculosis in a parotid Warthin's tumor: a case report and literature review. BMC Infect Dis. 2024;24(1):1298. https://doi.org/10.1186/s12879-024-10193-7 Momin MB, Amitha G, Aluri A, S S. Comparative analysis of GeneXpert assay in addition to Ziehl-Neelsen microscopy for detection of extrapulmonary tuberculosis in fine-needle aspiration samples. Sch J App Med Sci. 2017;5(7D):2803-2808. doi:10.36347/sjams.2017.v05i07.058. Agashe VM, Johari AN, Shah M, Anjum R, Romano C, Drago L, et al. Diagnosis of osteoarticular tuberculosis: perceptions, protocols, practices, and priorities in endemic and non-endemic areas of the world-a WAIOT view. Microorganisms. 2020;8(9):1-19. https://doi.org/10.3390/microorganisms8091312 Devi RS, Kumar A, Singh A, Durgapal P, Kishore S, Phulware RH. Cytological diagnosis of tuberculosis. J Cytol. 2024;41(1):1-9. Kim YH, Jeong WJ, Jung KY, Sung MW, Kim KH, Kim CS. Diagnosis of major salivary gland tuberculosis: experience of eight cases and review of the literature. Acta Otolaryngol. 2005;125(12):1318-1322. https://doi.org/10.1080/00016480510012246 Tarasova LG, Filinyuk OV. Orofacial tuberculosis: clinic, diagnosis, differential diagnosis. Tutorial. Tomsk: Siberian State Medical University. 2020:1-100. Chauhan R, Sultan M, Badhe P. Primary parotid tuberculosis presenting as a malignancy: an exceptional occurrence. EMJ Radiology. 2024;9(3):138-143. https://doi.org/10.33590/emj/hnqh1996 Geetha JP. Role of fine needle aspiration cytology and immunochromatographic test (ICT-TB) in the diagnosis of tuberculous lymphadenopathy [dissertation]. Bengaluru: Rajiv Gandhi University of Health Sciences. 2008:1-24. Baligar SS. Correlation of cytomorphologic changes at FNAC with the presence of acid-fast bacilli detected by the Ziehl–Neelsen and fluorescent stains in tuberculous lymphadenitis [dissertation]. Bengaluru: Rajiv Gandhi University of Health Sciences. 2014:1-24. Anaghashree US. Outcome of patients with extrapulmonary tuberculosis on treatment with anti-tubercular therapy [dissertation]. Bengaluru: Rajiv Gandhi University of Health Sciences. 2019:1-24. Maurya MK, Kumar S, Singh HP, Verma A. Tuberculous parotitis: a series of eight cases and review of literature. Natl J Maxillofac Surg. 2019;10(1):118-122. https://doi.org/10.4103/njms.njms_34_18 Azeez ZF, Al-Saadi ZH, Al QK. Diagnostic approaches for sexually transmitted infections in clinical microbiology: a comprehensive review. Infection. 2024;10(2):1-16. https://doi.org/10.55640/ijmsdh-10-02-07
Parotid tuberculosis, Pleomorphic adenoma mimic, FNAC, Acid-fast bacilli, Salivary gland swelling, Anti-tubercular therapy
Copyright (c) 2026 Journal of Recent Advances in Applied Sciences (pISSN 0970-1990)
Comparative Evaluation of Multidetector Computed Tomography Angiography & Color Doppler Ultrasonography in Lower Limb Peripheral Arterial Disease
Introduction: Peripheral arterial disease (PAD) is a common vascular disorder that necessitates precise imaging for accurate diagnosis and effective management. Among the available non-invasive imaging techniques, Color Doppler Ultrasonography (CDUS) and Multidetector Computed Tomography Angiography (MDCTA) are widely utilized, each offering unique benefits in vascular assessment. Aims & Objectives: This study aimed to evaluate and compare the diagnostic performance of CDUS and MDCTA in patients with lower limb PAD, focusing on their sensitivity, specificity, overall accuracy in grading arterial stenosis. Materials & Methods: A hospital-based descriptive cross-sectional study was carried out on 48 patients, accounting for 96 lower limbs, all clinically suspected of having PAD. Each participant underwent both CDUS and MDCTA examinations. Arterial stenosis was categorized into five groups: normal, mild (≤50%), moderate (50–70%), severe (≥70%), and complete occlusion. Statistical analysis was conducted using IBM SPSS version 26, with a p-value of less than 0.05 considered statistically significant. Results: Most participants were male (72.9%), with the highest proportion falling within the 61–70 years age group (39.6%). Claudication emerged as the most frequent presenting complaint (44.8%). CDUS demonstrated excellent sensitivity (100%) and high specificity (89.7%) when compared with MDCTA, achieving an overall diagnostic accuracy of 93.6%. There was near-perfect agreement between the two modalities (κ = 0.86), along with strong diagnostic performance (AUC = 0.93). However, CDUS showed a tendency to overestimate stenosis in infrapopliteal segments, where specificity was relatively reduced, while MDCTA provided better visualization of distal vessels. Conclusion: CDUS serves as a highly sensitive, non-invasive screening tool, especially effective for proximal arterial segments. MDCTA remains a reliable reference standard, offering superior anatomical detail and precise stenosis grading necessary for treatment planning. A combined imaging approach enhances diagnostic accuracy, particularly for evaluating distal arterial involvement. REFERENCES: Haider R. Peripheral vascular disease. Cardiol Res Rep. 2023;5(4):1-13. AbuRahma AF, Campbell JE. Overview of peripheral arterial disease of the lower extremity. In: AbuRahma AF, Bergan JJ, editors. Noninvasive Vascular Diagnosis: A Practical Textbook for Clinicians. Cham: Springer; 2022:449-488. https://doi.org/10.1007/978-3-030-60626-8_21 Khanna NN, Krishna V, Manjunath CN, Tyagi S, Jindal R, Chadha M, et al. The Indian consensus statement for the management of lower extremity peripheral artery disease. J Indian Coll Cardiol. 2023;13(1):1-20. https://doi.org/10.4103/1561-8811.383634 Krishnan MN, Geevar Z, Mohanan PP, Venugopal K, Devika S. Prevalence of peripheral artery disease and risk factors in the elderly: a community-based cross-sectional study from northern Kerala, India. Indian Heart J. 2018;70(6):808-815. https://doi.org/10.1016/j.ihj.2017.11.001 Fowkes FG, Aboyans V, Fowkes FJ, McDermott MM, Sampson UK, Criqui MH. Peripheral artery disease: epidemiology and global perspectives. Nat Rev Cardiol. 2017;14(3):156-170. https://doi.org/10.1038/nrcardio.2016.179 Abu-Fadel M. Complications of peripheral arterial interventions. In: Practical Approach to Peripheral Arterial Chronic Total Occlusions. Singapore: Springer; 2017: 95-122. https://doi.org/10.1007/978-981-10-3053-6_7 Narula N, Dannenberg AJ, Olin JW, Bhatt DL, Johnson KW, Nadkarni G, et al. Pathology of peripheral artery disease in patients with critical limb ischemia. J Am Coll Cardiol. 2018;72(18):2152-2163. https://doi.org/10.1016/j.jacc.2018.08.002 Bernatchez J, Fortin W, Boisvert A, Douville Y, Mao Y, Philippe É, et al. Peripheral arterial disease: what you need to know. In: Cardiovascular Explants: Biofunctionality, Biodurability and Biocompatibility. Cham: Springer Nature Switzerland; 2025: 91-139. https://doi.org/10.1007/978-3-031-85504-7_3 Sgroi MD, Chou EL, Wilson SE. Clinical examination of the vascular system. In: Vascular Surgery. Boca Raton (FL): CRC Press; 2017:79-88. Pollak AW, Norton PT, Kramer CM. Multimodality imaging of lower extremity peripheral arterial disease: current role and future directions. Circ Cardiovasc Imaging. 2012;5(6):797-807. https://doi.org/10.1161/circimaging.111.970814 Collins R, Burch J, Cranny G, Aguiar-Ibáñez R, Craig D, Wright K, et al. Duplex ultrasonography, magnetic resonance angiography, and computed tomography angiography for diagnosis and assessment of symptomatic lower limb peripheral arterial disease: systematic review. BMJ. 2007;334(7606):1-9. https://doi.org/10.1136/bmj.39217.473275.55 Tanaka R, Yoshioka K. Subtraction CT angiography for the evaluation of lower extremity artery disease with severe arterial calcification. J Cardiovasc Dev Dis. 2025;12(4):1-12. https://doi.org/10.3390/jcdd12040131 Malaichamy A, Pandian V, Arumugam T, Ravipati C, Malaichamy Sr A. Advances in vascular imaging: a comparative analysis of Doppler ultrasound and multidetector CT for lower limb peripheral arterial disease diagnosis. Cureus. 2024;16(6):1-10. https://doi.org/10.7759/cureus.62673 Zakir M, Tazeen A, Khan FN, Fatima M, Tauqir J, Ahmad T. Comparison of color Doppler and computed tomography angiography in arterial disease in patients with lower limb ischemia. Prof Med J. 2021;28(10):1381-1391. https://doi.org/10.29309/tpmj/2021.28.10.6375 Cansu A, Soyturk M, Ozturk MH, Kul S, Pulathan Z, Dinc H. Diagnostic value of color Doppler ultrasonography and MDCT angiography in complications of hemodialysis fistulas and grafts. Eur J Radiol. 2013;82(9):1436-1443. https://doi.org/10.1016/j.ejrad.2013.03.015 Lin YH, Tsai PS, Hung CL, Beg MF, Yeh HI, Yun CH, et al. The role of muscle density in predicting the amputation risk in peripheral arterial disease: a tissue composition study using lower extremity CT angiography. Diagnostics (Basel). 2025;15(11):1-15. https://doi.org/10.3390/diagnostics15111439 Pan Z, Wang R, Li L, Zhang H. Correlation between significant asymptomatic carotid artery stenosis and severity of peripheral arterial occlusive disease in the lower limb: a retrospective study on 200 patients. BMC Neurol. 2019;19(1):1-5. https://doi.org/10.1186/s12883-019-1485-1 Raskin D, Khaitovich B, Silverberg D, Halak M, Balan S, Rimon U. Primary retrograde dorsalis pedis artery single access for revascularization of chronic total occlusion in patients with critical limb ischemia. J Vasc Interv Radiol. 2019;30(4):554-559. https://doi.org/10.1016/j.jvir.2018.08.030 Kayhan A, Palabıyık F, Serinsöz S, Kırış A, Bayramoğlu S, Williams JT, et al. Multidetector CT angiography versus arterial duplex USG in diagnosis of mild lower extremity peripheral arterial disease: is multidetector CT a valuable screening tool? Eur J Radiol. 2012;81(3):542-546. https://doi.org/10.1016/j.ejrad.2011.01.100 Kosmala A, Weng AM, Schmid A, Gruschwitz P, Grunz JP, Bley TA, et al. Dual-energy CT angiography in peripheral arterial occlusive disease: diagnostic accuracy of different image reconstruction approaches. Acad Radiol. 2022;29:59-68. https://doi.org/10.1016/j.acra.2020.10.028 Elsaied FM, Sherief HM, Abdelwahab M. Reliability and dependency of color-coded duplex ultrasonography in comparison to multidetector computed tomography angiography in diagnosis and selection of treatment strategy of peripheral arterial disease of the lower limb. Al-Azhar Assiut Med J. 2015;13(4):116-119. https://doi.org/10.1136/bmj.c1298 Zhiqiang L, Yihua W, Ying F, Shiwei Z, Xiangzhu Z, Ligang C. The value of color Doppler ultrasonography combined with computed tomography angiography and magnetic resonance angiography in the preoperative quantification and classification of carotid body tumors: a retrospective analysis. BMC Med Imaging. 2024;24(1):1-10. https://doi.org/10.1186/s12880-023-01189-x Sultan W, Ahmad J, Kanwal P. Role of CT angiography and Doppler ultrasound in the evaluation of peripheral vascular diseases: a review on diagnostic challenges and insights from special populations. Electron J Med Res. 2025;1(1):78-95. https://doi.org/10.64813/ejmr.2025.014
Peripheral arterial disease, MDCT angiography, Color Doppler ultrasonography
Correlation between Carotid Artery Intima Media Thickness & Body Mass Index in Adult Hypertensive Patients using Bright Mode & Colour Doppler Ultrasonography
Introduction: Atherosclerosis remains a leading contributor to global morbidity and mortality. Carotid intima-media thickness (CIMT), assessed using B-mode ultrasonography, is widely recognized as a reliable surrogate marker for subclinical atherosclerosis. Hypertension and elevated body mass index (BMI) are established risk factors implicated in vascular remodeling. This study aimed to evaluate the association between CIMT and BMI among hypertensive adults. Aim & Objective: To measure CIMT using B-mode and color Doppler ultrasonography and to calculate BMI in adult hypertensive individuals, and to determine the correlation between these parameters for early identification of vascular complications. Materials & Methods: A cross-sectional study was conducted on 150 participants (75 hypertensive and 75 normotensive) aged over 30 years. CIMT was measured at multiple segments of the common carotid artery using a 5–13 MHz linear transducer. BMI was calculated using Quetelet’s formula. Statistical analysis was performed using Pearson’s correlation coefficient and chi-square test. Results: The mean age of participants was 61.7 ± 12.3 years. Hypertensive individuals exhibited significantly higher CIMT values compared to normotensive controls. Obesity was observed in 42% of the study population. CIMT demonstrated a strong positive correlation with systolic blood pressure (r = 0.843, p < 0.001), diastolic blood pressure (r = 0.814, p < 0.001), and hypertension grade (r = 0.75, p < 0.001). In contrast, the correlation between CIMT and BMI was weak and not statistically significant (r = 0.126, p = 0.069). Carotid plaques were detected in 45.33% of participants. Conclusion: CIMT was strongly associated with the severity of hypertension, whereas BMI did not show a significant independent correlation. These findings suggest that effective blood pressure control may play a more pivotal role than BMI alone in mitigating subclinical atherosclerosis in this population. 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Obesity and cardiovascular disease: risk factor, paradox, and impact of weight loss. J Am Coll Cardiol. 2009;53(21):1925-1932. Fernández-Friera L, Peñalvo JL, Fernández-Ortiz A, Ibañez B, López-Melgar B, Laclaustra M, et al. Prevalence, vascular distribution, and multiterritorial extent of subclinical atherosclerosis: the PESA study. Circulation. 2015;131(24):2104-2113. https://doi.org/10.1161/circulationaha.114.014310 Nambi V, Chambless L, Folsom AR, He M, Hu Y, Mosley T, et al. Carotid intima-media thickness and presence or absence of plaque improves prediction of coronary heart disease risk: the ARIC study. J Am Coll Cardiol. 2010;55(15):1600-1607. https://doi.org/10.1093/eurheartj/ehr192 Hotamisligil GS. Inflammation and metabolic disorders. Nature. 2006;444(7121):860-867. https://doi.org/10.1038/nature05485 Roxana, O.N.U.T., Balanescu, S., Constantinescu, D., Calmac, L., Marinescu, M. and Dorobantu, M., 2012. 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Assessment of subclinical atherosclerosis by CIMT: technical issues. Eur J Prev Cardiol. 2012;19(2 Suppl):18-24. https://doi.org/10.1177/2047487312448990 Sabry HH, Sabry JH, Daifalla AE, Akl EM, Hamed AM, Torky AA. Serum markers for asymptomatic atherosclerosis in psoriatic patients. Vasc Health Risk Manag. 2018;14:145-152. https://doi.org/10.2147/vhrm.s164274 van den Oord SC, Sijbrands EJ, ten Kate GL, van Klaveren D, van Domburg RT, van der Steen AF, et al. CIMT for cardiovascular risk assessment: systematic review. Atherosclerosis. 2013;228(1):1-7. https://doi.org/10.1016/j.atherosclerosis.2013.01.025 Järvisalo MJ, Raitakari M, Toikka JO, Putto-Laurila A, Rontu R, Laine S, et al. Endothelial dysfunction and increased IMT in type 1 diabetes. Circulation. 2004;109(14):1750-1755. https://doi.org/10.1161/01.cir.0000124725.46165.2c Zebekakis PE, Nawrot T, Thijs L, Balkestein EJ, van der Heijden-Spek J, Van Bortel LM, et al. Obesity and arterial stiffness. 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Carotid Intima-Media Thickness, Hypertension, Body Mass Index, Ultrasonography, Atherosclerosis, Doppler
Effect of Teriparatide on Fracture Healing in Intertrochanteric Fractures Treated with Proximal Femoral Nailing: A Prospective Comparative Study
Introduction: Intertrochanteric fractures are common in the elderly and are associated with significant morbidity and delayed functional recovery. Proximal femoral nailing (PFN) is a standard method of fixation; however, fracture healing may be compromised in osteoporotic bone. Teriparatide, an anabolic agent, has been proposed to enhance fracture healing. Aims & Objectives: To evaluate the effect of adjunctive teriparatide therapy on radiological union and functional outcomes in intertrochanteric fractures treated with PFN. Materials & Methods: A prospective randomized comparative study was conducted on 30 patients with intertrochanteric fractures at a tertiary care hospital over a 24-month period. Patients were allocated into two groups: Group A (PFN with teriparatide, n=15) and Group B (PFN alone, n=15). Group A received subcutaneous teriparatide (20 µg/day) starting on postoperative day 7 for 24 weeks. Functional outcomes were assessed using the Visual Analogue Scale (VAS), Lower Extremity Functional Scale (LEFS), and Harris Hip Score (HHS). Radiological assessment included cortical bridging, tip-apex distance (TAD), femoral offset, and neck-shaft angle (NSA). Results: Group A demonstrated significantly earlier fracture union (mean 11.2 weeks) compared to Group B (13.4 weeks). Patients receiving teriparatide showed better pain relief and functional scores during early follow-up (1–3 months, P < 0.05). However, functional outcomes and radiological parameters (TAD, NSA, and femoral offset) were comparable between groups at 6 months (P > 0.05). Complication rates were similar in both groups. Conclusion: Adjunctive teriparatide therapy accelerates biological fracture healing and improves early functional recovery in osteoporotic intertrochanteric fractures treated with PFN, without affecting final structural outcomes or increasing complications. References Boyd HB, Griffin LL. Classification and treatment of trochanteric fractures. Arch Surg. 1949;58(6):853-866. Cooper C, Campion G, Melton LJ III. Hip fractures in the elderly: a world-wide projection. Osteoporos Int. 1992;2(6):285-289. https://doi.org/10.1007/bf01623184 Gullberg B, Johnell O, Kanis JA. World-wide projections for hip fracture. Osteoporos Int. 1997;7(5):407-413. https://doi.org/10.1007/pl00004148 Kanis JA, Johnell O, Oden A, Sembo I, Redlund-Johnell I, Dawson A, et al. Epidemiology of hip fractures. Bone. 2003;32(5):463-473. https://doi.org/10.1016/s8756-3282(01)00418-5 Cummings SR, Melton LJ. Epidemiology and outcomes of hip fractures. Lancet. 2002;359(9319):1761-7. Parker MJ, Handoll HH. Surgical versus conservative treatment for hip fractures in adults. Cochrane Database Syst Rev. 2006;(4):1-10. https://doi.org/10.1002/14651858.cd000337 Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1973;55(7):1304-1321. https://doi.org/10.2106/00004623-197961020-00009 Baumgaertner MR, Curtin SL, Lindskog DM, Keggi JM. The value of the tip-apex distance in predicting failure of fixation of peritrochanteric fractures of the hip. J Bone Joint Surg Am. 1995;77(7):1058-1064. https://doi.org/10.2106/00004623-199507000-00012 Simmermacher RKJ, Bosch AM, Van der Werken C. The AO/ASIF proximal femoral nail in unstable trochanteric fractures. Injury. 1999;30(5):327-332. https://doi.org/10.1016/s0020-1383(99)00091-1 Kaufer H. Mechanics of the treatment of hip injuries. Clin Orthop Relat Res. 1980;(146):53-61. Strauss E, Frank J, Lee J, Kummer FJ, Koval KJ. Helical blade versus sliding hip screw for internal fixation of unstable intertrochanteric fractures: a biomechanical comparison. J Orthop Trauma. 2006;20(7):433-436. https://doi.org/10.1016/j.injury.2006.06.008 Riggs BL, Melton LJ. Involutional osteoporosis. N Engl J Med. 1986;314(26):1676-86. Eastell R, O'Neill TW, Hofbauer LC, Jagschies B, Reeve J, Vignoni M. Management of male osteoporosis. Lancet. 1998;352(9137):1347-1353. Neer RM, Arnaud CD, Zanchetta JR, Prince R, Gaich GA, Reginster JY, et al. Effect of parathyroid hormone (1-34) on fractures and bone mineral density in postmenopausal women with osteoporosis. N Engl J Med. 2001;344(19):1434-1441. https://doi.org/10.1097/00006254-200110000-00018 Aspenberg P, Genant HK, Johansson T, Nino AJ, See K, Krohn K, et al. Teriparatide for acceleration of fracture repair in humans: a prospective, randomized, double-blind study of 102 postmenopausal women with distal radial fractures. J Bone Miner Res. 2010;25(2):404-414. https://doi.org/10.1359/jbmr.090731 Bhandari M, Jin L, See K, Stegmueller B, Fernandes JC, Jönsson B, et al. Does teriparatide accelerate healing in osteoporotic hip fractures? A mid-term analysis. J Orthop Trauma. 2016;30(3):121-127. Larson CB, et al. Mechanical failure of fixation in intertrochanteric fractures. J Bone Joint Surg Am. 1974;56(3):483-492. Kyle RF, Gustilo RB, Premer RF. Analysis of six hundred and twenty-two intertrochanteric hip fractures. J Bone Joint Surg Am. 1991;73(1):123-136. https://doi.org/10.2106/00004623-197961020-00009 Jensen JS, Sonne-Holm S, Tøndevold E. Failure of internal fixation of intertrochanteric fractures. Acta Orthop Scand. 1980;51(1-6):803-810. Gardenbroek TJ, Segers MJ, Simmermacher RK, Hammacher ER. The proximal femur nail antirotation: an identifiable improvement in the treatment of unstable pertrochanteric fractures? J Trauma. 2011;71(1):169-174. https://doi.org/10.1097/ta.0b013e3182213c6e Varacallo MA, Fox EJ. Osteoporosis and its complications. Med Clin North Am. 2014;98(4):817-831. Einstein A, et al. Effect of osteoporosis on internal fixation stability. Clin Orthop Relat Res. 1995;(312):19-27. Lou S, Lv H, Wang G, Zhang L, Li M, Li Z, et al. The effect of teriparatide on fracture healing of osteoporotic patients: a meta-analysis of randomized controlled trials. Biomed Res Int. 2016;2016:1-10. https://doi.org/10.1155/2016/6040379 Bukata SV, et al. Systemic anabolic therapy for fracture healing. Clin Orthop Relat Res. 2011;469(8):2178-86. Yu W, et al. Teriparatide improves healing in unstable intertrochanteric fractures treated with PFN. Injury. 2020;51(2):236-243. Singhal S, et al. Role of teriparatide in intertrochanteric fracture healing. Indian J Orthop. 2018;52(5):507-514. Choi YJ, et al. Teriparatide after pertrochanteric fracture fixation. J Orthop Trauma. 2025;39(2):112-119. Wheeless CR III. Closed reduction of intertrochanteric fractures. In: Wheeless' Textbook of Orthopaedics. Durham (NC): Wheeless Online; 2026:1-11. https://doi.org/10.1002/cyto.990110308 Shapira J, Chen SL, Rosinsky PJ, Maldonado DR, Meghpara MB, Lall AC, Domb BG. The effect of postoperative femoral offset on outcomes after hip arthroplasty: a systematic review. J Orthop. 2020;22:5-11. https://doi.org/10.1016/j.jor.2020.03.034
Intertrochanteric fracture, Proximal femoral nail, Teriparatide, Fracture healing, Functional outcome
Diagnostic Value of Diffusion Weighted Imaging & MR Spectroscopy in Characterisation of Intracranial Neoplasms with Histopathological Correlation
Introduction: Intracranial neoplasms represent a heterogeneous group of lesions with varied biological behaviour, prognosis, and management strategies. Accurate preoperative characterization remains a diagnostic challenge, as conventional magnetic resonance imaging (MRI) often shows overlapping features among different tumor types. Aim & Objective: This study aimed to evaluate the diagnostic utility of diffusion-weighted imaging (DWI) and magnetic resonance spectroscopy (MRS) in the characterization of intracranial neoplasms, with histopathological examination as the reference standard. Material & Methods: A prospective observational study was conducted on 35 patients with suspected intracranial tumors. All patients underwent comprehensive MRI, including DWI with apparent diffusion coefficient (ADC) mapping and multivoxel MRS for metabolite analysis. Results: Quantitative parameters such as tumor and peritumoral ADC values, along with metabolite ratios (Cho/Cr, Cho/NAA, NAA/Cr), were analysed and correlated with histopathological findings. The mean tumor ADC value was 1.03 ± 0.30 ×10⁻³ mm²/s, with significantly lower values observed in high-grade tumors and lymphoma compared to low-grade tumors (p < 0.001). MRS demonstrated elevated choline and reduced NAA in neoplastic lesions, with higher Cho/Cr and Cho/NAA ratios in high-grade tumors. MRI showed high specificity (95.7%) and overall diagnostic accuracy of 85.7% in identifying high-grade gliomas, though sensitivity was moderate (66.7%). Conclusion: The combined use of DWI and MRS improved diagnostic confidence in tumor characterization, grading, and differentiation from other intracranial lesions. These advanced imaging techniques provide valuable non-invasive insights into tumor cellularity and metabolism, complementing conventional MRI and aiding in clinical decision-making. In conclusion, integration of DWI and MRS significantly enhances the diagnostic performance of MRI in intracranial neoplasms, with strong correlation to histopathology. REFERENCES: Maier S, Baur A, Flügel D, Lüdemann L, Knopp MV. Diffusion imaging of brain tumors. Eur J Radiol. 2010;76(3):376-387. Aydın ZB, Selek K, Erol FS, Demir MK, Öner YA. Diagnostic value of diffusion-weighted magnetic resonance imaging and proton MR spectroscopy in brain lesions: correlation with histopathology. Eur J Radiol. 2019;116:34-40. https://doi.org/10.7759/cureus.6409 Dawoud MA, Sherif MF, Eltomey MA. Apparent diffusion coefficient and magnetic resonance spectroscopy in grading of malignant brain neoplasms. Egypt J Radiol Nucl Med. 2014;45(4):1215-1222. https://doi.org/10.1016/j.ejrnm.2014.08.003 Gupta K, Jain N, Saggar K. Role of diffusion weighted imaging and MR spectroscopy in characterisation of intracranial neoplasms. Indian J Radiol Imaging. 2018;28(3):324-33. Calvar JA, Meli FJ, Romero C, Calcagno ML, Yánez PY, Martinez AR, et al. Characterization of brain tumors by MRS, DWI and Ki-67 labeling index. J Neurooncol. 2005;72(3):273-80. https://doi.org/10.1007/s11060-004-3342-2 Horská A, Barker PB. Imaging of brain tumors: MR spectroscopy and metabolic imaging. Neuroimaging Clin N Am. 2010;20(3):293-310. https://doi.org/10.1016/j.nic.2010.04.003 Elshafey R, Hassanien A, et al. 1H proton MR spectroscopy and diffusion-weighted imaging in discrimination between pyogenic brain abscesses and necrotic tumors. Egypt J Radiol Nucl Med. 2014;45(3):889-896. https://doi.org/10.1016/j.ejrnm.2014.01.010 Hirschler L, Sollmann N, Schmitz-Abecassis B, et al. Advanced MR techniques for preoperative glioma characterization: Part 1. J Magn Reson Imaging. 2023;57(6):1655-1675. Provenzale JM, Mukundan S Jr, Barboriak DP. Diffusion-weighted and perfusion MR imaging for brain tumor characterization and grading. Radiology. 2006;239(3):632-649. https://doi.org/10.1148/radiol.2393042031 Gujar SK, Maheshwari S, Björkman-Burtscher I, Sundgren PC. Magnetic resonance spectroscopy. J Neuroophthalmol. 2005;25(3):217-226. McKnight TR. Proton magnetic resonance spectroscopic evaluation of brain tumor metabolism. In: Perry MC, editor. Semin Oncol. 2004;31(5):605-617. Sugahara T, Korogi Y, Kochi M, Ikushima I, Hirai T, Okuda T, et al. Usefulness of diffusion-weighted MRI with echo-planar technique in the evaluation of cellularity in gliomas. J Magn Reson Imaging. 1999;9(1):53-60. https://doi.org/10.1002/(sici)1522-2586(199901)9:1<53::aid-jmri7>3.0.co;2-2 Weinberg BD, Kuruva M, Shim H, Mullins ME. Clinical applications of magnetic resonance spectroscopy in brain tumors: from diagnosis to treatment. Radiol Clin North Am. 2021;59(3):349-362. Wang QP, Lei DQ, Yuan Y, Xiong NX. Accuracy of ADC derived from DWI for differentiating high-grade from low-grade gliomas: a systematic review and meta-analysis. Medicine (Baltimore). 2020;99(8):1-9. https://doi.org/10.1097/md.0000000000019254 Zhang L, Min Z, Tang M, Chen S, Lei X, Zhang X. The utility of diffusion MRI with quantitative ADC measurements for differentiating high-grade from low-grade cerebral gliomas: evidence from a meta-analysis. J Neurol Sci. 2017;373:9-15. https://doi.org/10.1016/j.jns.2017.01.049 Kono K, Inoue Y, Nakayama K, Shakudo M, Morino M, Ohata K, et al. The role of diffusion-weighted imaging in patients with brain tumors. AJNR Am J Neuroradiol. 2001;22(6):1081-1088. Ko CC, Tai MH, Li CF, Chang HY, Chang YH, Chen TY, et al. Differentiation between glioblastoma multiforme and primary cerebral lymphoma: additional benefits of quantitative diffusion-weighted MR imaging. PLoS One. 2016;11(9):1-15. https://doi.org/10.1371/journal.pone.0162565 Suh CH, Kim HS, Jung SC, Kim SJ. Diffusion-weighted imaging and diffusion tensor imaging for differentiating high-grade glioma from solitary brain metastasis: a systematic review and meta-analysis. AJNR Am J Neuroradiol. 2018;39(7):1208-1214. https://doi.org/10.3174/ajnr.a5650 Guzman R, Altrichter S, El-Koussy M, et al. Contribution of the apparent diffusion coefficient in perilesional edema for the assessment of brain tumors. J Neuroradiol. 2008;35(4):224-229. https://doi.org/10.1016/j.neurad.2008.02.003 Lu S, Ahn D, Johnson G, Cha S. Peritumoral diffusion tensor imaging of high-grade gliomas and metastatic brain tumors. AJNR Am J Neuroradiol. 2003;24(5):937-941. Demir MK, Iplikcioglu AC, Dincer A, Arslan M, Sav A. Single voxel proton MR spectroscopy findings of typical and atypical intracranial meningiomas. Eur J Radiol. 2006;60(1):48-55. https://doi.org/10.1016/j.ejrad.2006.06.002 Chawla S, Zhang Y, Wang S, Poptani H, Melhem ER, Sehgal CM, et al. Proton magnetic resonance spectroscopy in differentiating glioblastomas from primary cerebral lymphomas and brain metastases. J Comput Assist Tomogr. 2010;34(6):836-841. https://doi.org/10.1097/rct.0b013e3181ec554e
Diffusion-Weighted Imaging; Magnetic Resonance Spectroscopy; Intracranial Neoplasms; Magnetic Resonance Imaging; Apparent diffusion coefficient
Intrapartum Cardiotocography Monitoring & Its Correlation with Fetomaternal Outcome
Introduction: Intrapartum fetal monitoring with cardiotocography (CTG) is essential for identifying fetal hypoxia and reducing perinatal morbidity and mortality. This study aims to correlate intrapartum CTG patterns with fetomaternal outcomes. Aims & Objectives: To identify CTG patterns associated with neonatal respiratory depression and to evaluate the mode of delivery among women with abnormal CTG. Materials & Methods: A prospective observational study was conducted on 100 pregnant women at ≥34 weeks of gestation in a tertiary care hospital. CTG patterns were classified as reassuring, suspicious, or pathological according to NICE guidelines. Maternal demographics, labor characteristics, and neonatal outcomes, including APGAR scores, birth asphyxia, NICU admissions, and cord blood pH were recorded and analyzed. Results: Pathological and suspicious CTG patterns were observed in 17% and 23% of cases, respectively. Significant associations were found between abnormal CTG and meconium-stained liquor (p<0.001), cesarean section (p<0.001), and instrumental delivery (p<0.001). All cases with reassuring CTG had normal vaginal deliveries without birth asphyxia. Neonatal outcomes, including low APGAR scores at 1 and 5 minutes, birth asphyxia, and NICU admission, were significantly associated with pathological and suspicious CTG patterns (p<0.001). Mean cord blood pH was significantly lower in pathological (7.04±0.11) and suspicious (7.01±0.1) groups compared to the reassuring group (7.17±0.1) (p<0.001). Conclusion: Intrapartum CTG monitoring is a valuable tool for predicting adverse perinatal outcomes. Pathological and suspicious CTG patterns correlate significantly with neonatal respiratory depression, increased cesarean section rates, and NICU admissions.
Cardiotocography, Intrapartum fetal monitoring, Perinatal outcome, APGAR score, Birth asphyxia
Impact of New WHO Labor Care Guide on Reducing Intrapartum Cesarean Section Rates at Tertiary Care Hospital - KDMCH, Mathura
Introduction: Global rise in cesarean section rates necessitate innovative approaches to intrapartum care. The World Health Organization introduced the Labor Care Guide (LCG) in 2020 as a next-generation partograph emphasizing respectful parturient care, evidence-based monitoring, shared decision making and with good birthing experience. Aims & Objectives: To evaluate the effect of the WHO LCG on labor outcomes, particularly cesarean delivery rates, maternal complications, duration of hospital stay, and neonatal outcomes compared to the modified WHO partograph. Materials & Methods: A prospective randomized controlled trial was conducted at K.D. Medical College Hospital, Mathura, including 203 antenatal women (37-40 weeks gestation) in spontaneous active labor with cephalic presentation. Women were randomly allocated to monitoring with WHO LCG (study group, n=101) and modified WHO partograph (control group, n=102). Outcomes assessed included mode of delivery, active labor duration, maternal complications, hospital stay, Apgar scores, and NICU admissions. Results: Epidemiological characteristics including age and parity were comparable between both groups (study and control). Cesarean section rate was significantly lower in the study group (10.89%) compared to controls (32.35%) (p=0.0002), with an absolute risk reduction of 21.5%. Active labor duration was significantly shorter in the study group (p<0.0001). Mean hospital stay was reduced in the study group (3.32 vs 3.97 days, p=0.005). Neonatal outcomes including Apgar scores and NICU admissions were comparable between groups. Logistic regression showed LCG use independently reduced prolonged hospitalization odds by 52% (AOR 0.48, p=0.012). Conclusion: Implementation of the WHO Labor Care Guide significantly reduced intrapartum cesarean section rates and shortened the hospital stay without compromising maternal or neonatal safety, supporting its adoption in tertiary care settings.
Labor Care Guide, Cesarean section, Partograph, Intrapartum care, Maternal outcomes
Prevalence of Subclinical Hypothyroidism in Polycystic Ovarian Syndrome
Introduction: Polycystic ovarian syndrome (PCOS) and hypothyroidism are common endocrine disorders affecting women of reproductive age, sharing clinical features such as menstrual irregularities, obesity, and infertility. This study aims to assess the prevalence of subclinical hypothyroidism (SCH) in women diagnosed with PCOS. Aim & Objective: To evaluate the prevalence of SCH in PCOS patients diagnosed using Rotterdam criteria, and to correlate thyroid dysfunction with clinical, anthropometric, and ultrasonographic parameters. Materials & Methods: An observational cross-sectional study was conducted among 80 reproductive-age women diagnosed with PCOS at a tertiary care hospital. Detailed history, anthropometric measurements (BMI, waist-hip ratio), clinical assessment for hyperandrogenism, thyroid profile (FT3, FT4, TSH), and transabdominal ultrasonography were performed. SCH was defined as elevated TSH with normal FT3 and FT4. Results: The mean age of participants was 24.63 ± 5.09 years. The majority were overweight (37.5%) or obese (38.75%). Menstrual irregularities were present in 90% of women. The prevalence of SCH was 18.75%, while 7.50% had overt hypothyroidism. The most common PCOS phenotype was O+H+P (53.75%). No statistically significant association was found between thyroid status and age, BMI, WHR, PCOS phenotype, or clinical features including acne, hirsutism, and menstrual complaints (p>0.05). However, a higher proportion of SCH was noted in patients with hair loss (33.3%) and heavy menstrual bleeding (23.1%). Conclusion: Subclinical hypothyroidism is prevalent in nearly one-fifth of women with PCOS, supporting routine thyroid screening in this population for early detection and management of thyroid dysfunction. REFERENCES Bai H, Ding H, Wang MJC. Polycystic ovary syndrome (PCOS): symptoms, causes, and treatment. J Obstet Gynecol. 2024;51(5):1-12. https://doi.org/10.31083/j.ceog5105126 Ganie MA, Chowdhury S, Malhotra N, Sahay R, Bhattacharya PK, Agrawal S, et al. Prevalence, phenotypes, and comorbidities of polycystic ovary syndrome among Indian women. 2024;7(10):1-15. https://doi.org/10.2196/preprints.23437 Sharma A, Sarwal Y, Devi NK, Saraswathy KN. Polycystic ovary syndrome prevalence and associated sociodemographic risk factors: a study among young adults in Delhi NCR, India. Reprod Health. 2025;22(1):1-12. https://doi.org/10.1186/s12978-025-02019-9 Almhmoud H, Alatassi L, Baddoura M, Sandouk J, Alkayali MZ, Najjar H, et al. Polycystic ovary syndrome and its multidimensional impacts on women's mental health: a narrative review. Medicine (Baltimore). 2024;103(25):1-11. https://doi.org/10.1097/md.0000000000038647 Christ JP, Cedars MI. Current guidelines for diagnosing PCOS. Diagnostics (Basel). 2023;13(6):1-11. https://doi.org/10.3390/diagnostics13061113 Yasmin A, Roychoudhury S, Paul Choudhury A, Ahmed AF, Dutta S, Mottola F, et al. Polycystic ovary syndrome: an updated overview foregrounding impacts of ethnicities and geographic variations. Life (Basel). 2022;12(12):1-14. https://doi.org/10.3390/life12121974 Krishna D, Deepika K. Polycystic ovary syndrome. In: Principles and Practice of Assisted Reproductive Technology. 2019:479-522. https://doi.org/10.5005/jp/books/18020_36 Salman AG, Mahdi IA, Mukhlef AK, Mohammad RA, Zaghir MSH, Wadaa'a M, et al. Physiological aspects of thyroid disorders: anatomy, hormones, diagnosis and management. Clin Case. 2024;2(5):17-32. Gosi SKY, Kaur J, Garla VV. Subclinical hypothyroidism. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2024:1-10. Maraka S, Singh Ospina NM, Mastorakos G, O'Keeffe DT. Subclinical hypothyroidism in women planning conception and during pregnancy: who should be treated and how? J Endocr Soc. 2018;2(6):533-546. https://doi.org/10.1210/js.2018-00090 Practice Committee of the American Society for Reproductive Medicine. Subclinical hypothyroidism in the infertile female population: a guideline. Fertil Steril. 2015;104(3):545-553. https://doi.org/10.1016/j.fertnstert.2025.09.030 He J, Lai Y, Yang J, Yao Y, Li Y, Teng W, et al. The relationship between thyroid function and metabolic syndrome and its components: a cross-sectional study in a Chinese population. Front Endocrinol (Lausanne). 2021;12:1-10. https://doi.org/10.3389/fendo.2021.661160 Palomba S, Colombo C, Busnelli A, Caserta D, Vitale G. Polycystic ovary syndrome and thyroid disorder: a comprehensive narrative review of the literature. Front Endocrinol (Lausanne). 2023;14:1-23. https://doi.org/10.3389/fendo.2023.1251866 Gawron IM, Baran R, Derbisz K, Jach R. Association of subclinical hypothyroidism with present and absent anti-thyroid antibodies with PCOS phenotypes and metabolic profile. J Clin Med. 2022;11(6):1-12. https://doi.org/10.3390/jcm11061547 Ding X, Yang L, Wang J, Tang R, Chen Q, Pan J, et al. Subclinical hypothyroidism in polycystic ovary syndrome: a systematic review and meta-analysis. Front Endocrinol (Lausanne). 2018;9:1-7. https://doi.org/10.3389/fendo.2018.00700 Shekarian A, Mazaheri-Tehrani S, Shekarian S, Pourbazargan M, Setudeh M, Abhari AP, et al. Prevalence of subclinical hypothyroidism in polycystic ovary syndrome and its impact on insulin resistance: a systematic review and meta-analysis. BMC Endocr Disord. 2025;25(1):1-14. https://doi.org/10.1186/s12902-025-01896-2 Polyzos NP, Sakkas E, Vaiarelli A, Poppe K, Camus M, Tournaye H. Thyroid autoimmunity, hypothyroidism and ovarian reserve: a cross-sectional study of 5000 women based on age-specific AMH values. Hum Reprod. 2015;30(7):1690-1696. https://doi.org/10.1093/humrep/dev089 Al-Ruthia YS, Balkhi B, AlGhadeer S, Mansy W, AlSanawi H, AlGasem R, et al. Relationship between health literacy and body mass index among Arab women with polycystic ovary syndrome. Saudi Pharm J. 2017;25(7):1015-1018. https://doi.org/10.1016/j.jsps.2017.04.003 Pervin HH, Kazal RK, Rahman AS, Pervin T, Fatema K, Chowdhury SA, et al. Thyroid disorders in women with polycystic ovary syndrome. J Biosci Med. 2020;8(4):128-136. https://doi.org/10.4236/jbm.2020.84012 Rubin KH, Andersen MS, Abrahamsen B, Glintborg D. Socioeconomic status in Danish women with polycystic ovary syndrome: a register-based cohort study. Acta Obstet Gynecol Scand. 2019;98(4):440-450. https://doi.org/10.1111/aogs.13514 Hochberg A, Badeghiesh A, Baghlaf H, Tseva AT, Dahan MH. The effect of socioeconomic status on adverse obstetric and perinatal outcomes in women with polycystic ovary syndrome: an evaluation of a population database. Int J Gynaecol Obstet. 2024;165(1):275-281. https://doi.org/10.1002/ijgo.15201 Nayak PK, Mitra S, Sahoo J, Mahapatra E, Agrawal S, Lone Z. Relationship of subclinical hypothyroidism and obesity in polycystic ovarian syndrome patients. J Family Med Prim Care. 2020;9(1):147-150. https://doi.org/10.4103/jfmpc.jfmpc_654_19 Zhu M, Wang K, Feng J, Liu Y, Guan M, Wang Y, et al. The waist-to-height ratio is a good predictor for insulin resistance in women with polycystic ovary syndrome. Front Endocrinol (Lausanne). 2024;15:1-10. https://doi.org/10.3389/fendo.2024.1502321 Dai F, Wu Z, Qin S, Wu F, Wang M, Liu X, et al. The influence of subclinical hypothyroidism on endocrine and metabolic characteristics in patients with polycystic ovary syndrome. Int J Womens Health. 2025;17:1019-1026. https://doi.org/10.2147/ijwh.s517997 Lauritsen MP, Bentzen JG, Pinborg A, Loft A, Forman JL, Thuesen LL, et al. The prevalence of polycystic ovary syndrome in a normal population according to the Rotterdam criteria versus revised criteria including anti-Müllerian hormone. Hum Reprod. 2014;29(4):791-801. https://doi.org/10.1093/humrep/det469 Nanda SS, Dash S, Behera A, Mishra B. Thyroid profile in polycystic ovarian syndrome. J Evol Med Dent Sci. 2014;3(37):9594-9601. https://doi.org/10.14260/jemds/2014/3242 Bedaiwy MA, Abdel-Rahman MY, Tan J, AbdelHafez FF, Abdelkareem AO, Henry D, et al. Clinical, hormonal, and metabolic parameters in women with subclinical hypothyroidism and polycystic ovary syndrome: a cross-sectional study. J Womens Health (Larchmt). 2018;27(5):659-664. https://doi.org/10.1089/jwh.2017.6584 Penumalla HH, Kandimalla R. Hypothyroidism and its impact on menstrual irregularities in reproductive-age women: a comprehensive analysis at a tertiary care center. Cureus. 2024;16(6):1-10. https://doi.org/10.7759/cureus.63158 Tagliaferri V, Romualdi D, Guido M, Mancini A, De Cicco S, Di Florio C, et al. The link between metabolic features and TSH levels in polycystic ovary syndrome is modulated by body weight: an euglycaemic-hyperinsulinaemic clamp study. Eur J Endocrinol. 2016;175(5):433-441. https://doi.org/10.1530/eje-16-0358 AlFaisal AHM, Al-Deresawi MSG. The correlation between thyroid hormones, reproductive hormones, body mass index and hirsutism in Iraqi women with polycystic ovary syndrome. J Univ Anbar Pure Sci. 2013;7:1-6. https://doi.org/10.37652/juaps.2013.84922 Shah AK, Sarin M, Karunanand B, Mohapatra S, Bhat SA. Association of hormonal status with anthropometric and biochemical parameters in women with polycystic ovarian syndrome. 2017;3(4):1-5. Reema S, Khanam D. Impact of subclinical hypothyroidism on clinical, biochemical, hormonal and anthropometrical profile in polycystic ovarian syndrome. Fertil Reprod. 2023;5(1):15-20. https://doi.org/10.1142/s2661318223500019 Rahbar AR, Kalantarhormozi M, Izadi F, Arkia E, Rashidi M, Pourbehi F, et al. Relationship between body mass index, waist-to-hip ratio, serum lipid concentrations and thyroid-stimulating hormone in the euthyroid adult population. Iran J Med Sci. 2017;42(3):301-307. Ganie MA, Laway BA, Wani TA, Zargar MA, Nisar S, Ahamed F, et al. Association of subclinical hypothyroidism and phenotype, insulin resistance, and lipid parameters in young women with polycystic ovary syndrome. Fertil Steril. 2011;95(6):2039-2043. https://doi.org/10.1016/j.fertnstert.2011.01.149
Polycystic ovary syndrome, Subclinical hypothyroidism, Thyroid stimulating hormone, Rotterdam criteria, Hyperandrogenism, Menstrual irregularities
Functional Outcomes of Multiligament Reconstruction in Traumatic Knee Injuries: A Case Report
Introduction: Multiligament knee injuries (MLKIs) are uncommon but severe traumatic injuries involving the disruption of two or more major knee ligaments. These injuries are associated with significant instability, impaired knee function, and poor long-term outcomes if inadequately treated. Advances in arthroscopic reconstruction techniques and structured rehabilitation have improved functional recovery. Aim & Objective: To evaluate the functional outcome of a traumatic multiligament knee injury managed with multiligament knee injury involving the ACL, PCL, and MCL. Materials & Methods: A 39-year-old male presented after a road traffic accident with severe knee pain and inability to bear weight. Clinical examinations revealed positive anterior drawer, posterior drawer, and valgus stress tests. MRI confirmed complete ACL, PCL, and MCL tears with PCL femoral avulsion. The patient underwent arthroscopic ACL reconstruction using an ipsilateral peroneus longus tendon autograft, PCL avulsion repair, and open MCL reconstruction with a hamstring tendon graft, followed by a standardized rehabilitation protocol. Results: At the nine-month follow-up, the patient demonstrated excellent functional recovery. He was able to walk independently without pain or instability, had no episodes of knee giving way or clicking, comfortably performed cross-legged sitting and squatting, and achieved a knee range of motion from 0° to 130°. Conclusion: Early anatomical reconstruction combined with a structured rehabilitation program can result in excellent functional outcomes following multiligament knee injuries. Individualized surgical planning based on the pattern of ligament injury and patient-specific functional demands is essential for restoring knee stability and achieving optimal recovery.
Multiligament knee injury, ACL reconstruction, PCL avulsion, MCL reconstruction, Arthroscopy, Functional outcome.
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
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