Amala Institute of Medical Sciences is a private medical college near Amalanagar, in Thrissur city, of Kerala state. It is a Christian minority institution established and administered by the Devamatha Province of the Carmelites of Mary Immaculate (CMI), an indigenous religious congregation founded in 1831.
Background VEXAS syndrome is a recently recognized, acquired monogenic adult onset hemato-inflammatory syndrome characterized by somatic mutations within the UBA1 gene. The acronym VEXAS stands for vacuoles, E1 enzyme, X-linked inheritance, autoinflammatory tendencies, and somatic mutations. It presents as a severe progressive disease displaying varied characteristics that bridge hematologic and rheumatologic domains. Herein, we describe a series with a detailed evaluation of 11 cases of VEXAS syndrome. Materials and methods A comprehensive retrospective analysis of patients diagnosed with VEXAS syndrome over the last 5 years (2020-2025) was conducted. Data on clinical presentation, histopathological findings, genetic characteristics, and outcomes were recorded for systematic characterization. Results A total of 11 cases of VEXAS syndrome were identified. All the patients were males with an age range from 42 to 77 years. Prominent clinical characteristics included history of fever (11), arthritis/arthralgia (10), inflammatory skin lesions (7), vasculitis (6), ocular inflammatory conditions (6), relapsing polychondritis (6), unprovoked venous thrombosis (5), and auricular chondritis (4). Persistent unexplained cytopenia was present in all the patients, manifesting as anemia (10, 8 of which were macrocytic), thrombocytopenia (4), and neutropenia (2). Bone marrow examination was performed in nine cases, five showed morphologic dysplasia. Furthermore, all nine cases characteristically showed cytoplasmic vacuolations in hematopoietic precursors. UBA1 somatic mutations included p.Met41Thr (c.122 T>C Exon 3) (55%), p.Met41Val (c.121 A>G Exon 3) (27%), p.Met41Leu (c.121 A>C Exon 3) (9%), and a variant in the acceptor splice site of Exon 3 (c.118 G>C) (9%). p.Met41Val is associated with inferior overall survival (OS). Conclusion This study characterizes the clinical, morphologic, and laboratory features of VEXAS syndrome and presents the first comprehensive patient cohort from India. With a complex and heterogeneous clinical profile, awareness of the disease is particularly essential among hematologists, rheumatologists, and dermatologists for accurate diagnosis and management.
Carbon dots (CDs) are gaining popularity due to their unique physicochemical features and broad-spectrum antibacterial uses. Their high biocompatibility, adjustable photoluminescence, and adaptable surface chemistry make them interesting candidates for treating bacterial infections, especially those caused by multidrug-resistant (MDR) pathogens. CDs possess antibacterial properties through various mechanisms, including the formation of reactive oxygen species (ROS), disruption of bacterial membranes, inhibition of quorum sensing, and degradation of biofilms. In comparison with typical quantum dots, CDs have decreased toxicity, increased stability, and environmentally friendly synthesis alternatives, notably from biological and sustainable sources. These qualities make them useful for biomedical applications such as antimicrobial coatings, biofilm destruction, bacterial imaging, and targeted medication administration. This review objectively assesses the structural variation, synthesis techniques, and antibacterial processes of CDs, highlighting their therapeutic applications. Furthermore, we describe advances in surface modification, green synthesis methodologies, and their incorporation into multifunctional antimicrobial systems. CDs are a potential class of nanomaterials that can revolutionize antibacterial therapy by delivering novel strategies to prevent antimicrobial resistance and enhance infection control.
Recent studies have highlighted the pivotal role of the kynurenine pathway (KP) in systemic inflammatory disorders. Although KP modulation has been explored in diseases such as dementia and schizophrenia, its therapeutic potential in rheumatologic diseases remains largely unexplored. The objective of this article is to explore the potential role of the galantamine-memantine combination, with or without N-acetylcysteine (NAC), in regulating KP metabolism and its possible relevance to the pathophysiology of rheumatologic diseases. This article proposes a novel therapeutic strategy involving a combination of galantamine, a modulator of nicotinic receptor, and memantine, a N-methyl-D-aspartate receptor antagonist, with or without NAC, to target KP dysfunction in rheumatologic diseases. Galantamine and memantine may exert synergistic neuroimmune effects by reducing the production of neurotoxic KP metabolites, such as quinolinic acid, while promoting protective branches of the pathway. NAC, through its antioxidant properties, may further support this approach by mitigating oxidative stress and restoring immune balance. This combined therapy seeks to address key mechanisms of inflammatory rheumatologic diseases such as rheumatoid arthritis, systemic lupus erythematosus, ankylosing spondylitis, osteoarthritis, and psoriatic arthritis. This multifaceted approach may represent a potential direction for the treatment of rheumatologic diseases by integrating metabolic, neuroimmune, and antioxidant pathways. If future studies support the proposed mechanistic interactions, galantamine-memantine combination could potentially be explored as an adjunctive strategy alongside existing therapies. However, its clinical impact on treatment requirements or health care costs remains unknown and requires investigation in well designed randomized controlled trials. SIGNIFICANCE STATEMENT: A growing body of evidence in rheumatologic diseases implicates the kynurenine pathway (KP) metabolism. The galantamine-memantine combination, with or without N-acetylcysteine, through its regulatory action in KP could potentially be explored as an adjunctive strategy alongside existing therapies. Future randomized controlled trials are essential to establish efficacy, safety, and optimal patient selection.
Background Accurate preoperative assessment of endometrial cancer is essential for optimal surgical planning and prognostication. Cervical stromal invasion upstages the disease to stage II and often necessitates a more radical surgical approach. Magnetic resonance imaging (MRI) is considered the imaging modality of choice for local staging due to its superior soft-tissue contrast and multiplanar capability. Objective To evaluate the diagnostic accuracy of preoperative contrast-enhanced MRI in detecting cervical stromal invasion in patients with endometrial cancer, using postoperative histopathological examination as the reference standard. Methods This prospective observational study was conducted at a tertiary care center from June 2020 to October 2021. A total of 30 patients with histologically confirmed stage I or stage II endometrial carcinoma underwent preoperative contrast-enhanced pelvic MRI. MRI findings were compared with postoperative histopathological results. Diagnostic performance was assessed using sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, and Youden's J index. Results The mean age of the study population was 59 years, and most patients were postmenopausal with early-stage disease. Cervical stromal invasion was identified in 4 patients (13.3%) on MRI and in 5 patients (16.7%) on histopathological examination. MRI demonstrated a sensitivity of 80% and specificity of 100%, with a PPV of 100% and NPV of 96.2%. The overall diagnostic accuracy was 96.77%, and Youden's J index was 0.8. Conclusion Preoperative contrast-enhanced MRI demonstrates high diagnostic accuracy and excellent specificity in detecting cervical stromal invasion in endometrial cancer. It is a reliable modality for preoperative staging and may aid in guiding surgical management. Further multicenter studies with larger sample sizes are required to validate these findings.
Abstract Introduction: Antimicrobial resistance (AMR) continues to rise owing to inappropriate antimicrobial use. In many countries, especially where patients cannot afford repetitive physician consultations, patients self-prescribe antimicrobials even for self-limiting infections like pharyngitis. Well-trained pharmacists capable of effectively managing pharyngitis through clinical decision-making scores (CDS) like Centor/McIsaac score can aid antimicrobial stewardship programs (ASP). The main aim of the current study was to train pharmacists to apply validated clinical decision criteria (Centor/McIsaac) for the differential assessment of pharyngitis, promote guideline-based antimicrobial dispensing, and evaluate the effectiveness of training. Methods: A cross-sectional, interventional study using a combination of convenience sampling and snowball sampling techniques was conducted among pharmacists and clinical pharmacy trainees in Pakistan. Educational material was developed through extensive literature search, and training sessions were conducted at community pharmacies and academic institutes. Knowledge was assessed before and after the training sessions using a self-developed, validated, structured questionnaire. Results: Of the 288 participants, majority of the practicing pharmacists at community pharmacies were younger than 30 years of age with an experience of less than 3 years. Most participants demonstrated poor baseline knowledge which imporved significantly following the training intervention, highlighting its effectiveness in enhancing the knowledge, beliefs, and perceptions of AMR and AMS. Discussion: Microteaching-based continuing professional development interventions can support the clinical competencies of pharmacists. These findings highlight the potential of such training interventions to improve infection management and antimicrobial stewardship and underscore the need for similar tailored programs for other clinical conditions.
