All India Institute of Medical Sciences Raipur

PURPOSE: Aberrant Internal carotid artery (ICA) within the middle ear is a rare congenital vascular anomaly, occurring in approximately 1% of the population [1]. It often remains clinically silent or presents with nonspecific otological symptoms, making preoperative diagnosis challenging. This study aims to highlight the importance of early identification and safe management of aberrant ICA through a clinical case and literature review. METHODS: We report a case of 36 year old female presenting with bilateral chronic ear discharge and tympanic membrane retraction. Detailed otoscopic examination and radiological imaging were performed. A focused literature review was conducted to contextualize clinical presentation, diagnostic strategies and management. RESULTS: Imaging revealed an aberrant ICA coursing through the middle ear. The patients presentation was non specific, and the diagnosis was established only after radiological evaluation. Recognition of this anomaly preoperatively prevented inadvertent vascular injury. Literature suggests that such cases are frequently diagnosed incidentally, with intraoperative hemorrhage being the most severe complication when missed. CONCLUSION: Preoperative identification of aberrant ICA is critical in patients with atypical middle ear findings. Routine consideration of vascular anomalies and appropriate imaging can avert life threatening complications and guide safe surgical planning.

The magnitude of the problem of sickle cell disease (SCD) in India is very large and diverse. For people living with SCD there are several unmet health care needs making it pertinent to focus on recognizing the important public health burden of SCD in the country. In a bid to achieve this goal, the Indian College of Hematology (ICH) of the Indian Society of Hematology and Blood Transfusion (ISHBT) in collaboration with Indian Council of Medical Research (ICMR) has formulated a Guideline on Management and Control of Sickle Cell Disease in India. This was achieved by a national taskforce comprising top experts from the field who held multiple sessions to deliberate on different aspects and form consensus on preparing a comprehensive document on SCD care in India. The taskforce has presented its recommendations on various aspects of SCD in India, all of which have been evaluated based on the best evidence. Where the evidence was weak, the recommendations have been based on consensus among the experts. This review which is adapted from the comprehensive guideline document gives a concise treatise on various aspects of sickle cell disease in India along with specific recommendations. The section on screening and diagnosis provides an evidence-based background to scientifically select the most appropriate and feasible test option(s) in various Indian practice settings. The other aspects covered in this review are management of SCD in stable condition, iron overload and chelation therapy, vaso-occlusive crisis, management of other complications of SCD, blood transfusion in SCD, haematopoietic stem cell transplant and gene therapy in SCD, immunization and antibiotic prophylaxis in SCD and monitoring of patients with SCD. It also gives guidance on special circumstances such as pregnancy and surgery in SCD. It concludes with a note on prevention and control of SCD in India with an outline of a defined roadmap to make this possible.

Fibronectin (FN1), a vital extracellular matrix protein, has been reported to be elevated in blood and cerebrospinal fluid in epileptic patients exhibiting recent seizure activity. A transcriptomic study from MTLE-HS patients has identified FN1 as a potential gene linked to MTLE. Nonetheless, the function of FN1 and the participation of the FN1/α5β1-Integrin/Src kinase signaling pathway are yet to be fully investigated in both pre-clinical and clinical investigations of TLE. Furthermore, its role in NMDA receptor-mediated hyperexcitability in TLE requires investigation. This study evaluates the contribution of the FN1/α5β1-Integrin/Src kinase axis in facilitating NMDA-induced hyperexcitability in temporal lobe epilepsy. Hippocampal formation and ATL tissues from MTLE-HS patients, as well as acute and chronic Li-pilocarpine TLE rat models, were examined using qRT-PCR, immunoblotting, and ex vivo immunolabeling to evaluate the expression of FN1, α5β1 Integrin, Src kinase, and NMDA receptor subunits. To assess the functions of FN1 and Src in NMDA receptor-induced hyperexcitability, siRNA-mediated knockdown was conducted in TLE rats. Following knockdown, behavioral assessments, molecular studies, and in vivo EEG were employed to examine the FN1/α5β1 Integrin/Src axis in seizure-related hyperexcitability.In MTLE-HS patients and TLE rat models, FN1 and Src kinase showed upregulation in both the hippocampal formation and ATL, together with increased α5β1 Integrin levels in rats. Elevated Src activity was associated with augmented phosphorylation of NMDA receptors. The siRNA-mediated knockdown of FN1 or Src diminished NMDA receptor phosphorylation and markedly reduced seizure activity in TLE animals. Our research suggests that FN1 has a role in MTLE pathophysiology and may regulate NMDAR-mediated hyperexcitability via the FN1/α5β1 Integrin/Src kinase pathway. This pathway regulates seizures via the hippocampal formation and anterior temporal lobe networks. The therapeutic potential of targeting this signaling pathway for epilepsy needs additional investigation.

INTRODUCTION:Typhoid fever, caused by Salmonella typhi and Paratyphi, remains a significant public health concern, particularly in developing countries. The emergence of antimicrobial resistance, including resistance to first-line drugs, fluoroquinolones, and the development of resistance to ceftriaxone, poses a significant threat to effective treatment. METHODS:This study investigated extended-spectrum β-lactamase (ESBL)-producing Salmonella typhi isolates from blood samples of patients with suspected typhoid fever at a tertiary care hospital in Western Rajasthan, India, between April 2022 and May 2024. Antimicrobial susceptibility testing followed by PCR for ESBL-producing genes (blaTEM, blaSHV, blaCTX-M) and blaCTX-M subtypes (blaCTX-M1, blaCTX-M2, blaCTX-M8, blaCTX-M9, blaCTX-M10, blaCTX-M14, and blaCTXM15) was performed. RESULTS:Among 79 Salmonella typhi isolates, 18 (22.8%) exhibited resistance to ceftriaxone. PCR analysis revealed blaCTX-M as the predominant ESBL gene, detected in 77.8% of resistant isolates. Notably, blaCTX-M1, blaCTX-M15, and blaCTX-M10 types were identified among the blaCTX-Mpositive isolates. DISCUSSION:In our study, 48% of Salmonella typhi strains were resistant to fluoroquinolones, while chloramphenicol and co-trimoxazole showed re-emerging susceptibility (87%), likely due to their restricted use. Emerging ceftriaxone resistance, mediated by ESBL genes, predominantly blaCTX-M (especially blaCTX-M-15 and blaCTX-M-1) and blaSHV, poses challenges in clinical management. Notably, our study detected blaCTX-M10, which has not been previously reported in S. Typhi. Resistance gene spread is attributed to plasmids prevalent in E. coli and Klebsiella, which facilitate horizontal transfer. Study limitations include a small sample size, the absence of whole-genome sequencing, and a lack of clinical outcome data. CONCLUSION:This study highlights the emergence of ceftriaxone-resistant Salmonella typhi in Western Rajasthan, India. The high prevalence of blaCTX-M-producing isolates underscores the importance of ongoing surveillance and the implementation of infection control measures to prevent the further spread of antimicrobial resistance. Additionally, this study also highlights the re-emergence of sensitivity to chloramphenicol and co-trimoxazole.

Intimate partner homicide remains a major yet underreported public health concern, with most attention focused on male perpetrators and female victims. Female-perpetrated spousal homicides, especially those masked as accidents or suicides, often escape early detection due to gender-based investigative biases. This paper presents three cases of staged marital homicides investigated at a tertiary-care hospital in Delhi, where wives killed their husbands and fabricated misleading scenarios of accidental or self-inflicted deaths. Detailed autopsy examinations revealed consistent signs of homicidal ligature strangulation—such as patterned ligature marks, neck muscle hemorrhages, thyroid cartilage fractures, and systemic asphyxial changes—contradicting the alleged histories. Two of the perpetrators later confessed, validating the forensic conclusions. The series also highlights the need to recognize and document female-perpetrated intimate partner homicides within the Indian context, where societal expectations and cognitive biases may obscure objective investigation. By revealing “three lies and one truth,” this study emphasizes the role of forensic pathology in establishing cause of death and advancing awareness of gender-neutral homicide investigation.