Bangalore Medical College and Research Institute,Rajiv Gandhi University of Health Sciences

Abstract Introduction Allergic rhinitis is a global health problem causing significant impairment of quality of life and incurring a large health care expenditure. Various medical and surgical treatment modalities are available for the treatment of allergic rhinitis. The inferior turbinate plays a central role in allergic rhinitis, as it is the primary site where allergens are first deposited and undergoes hypertrophy leading to nasal obstruction which does not respond for medical management for long standing cases which necessitates surgical management. The purpose of the study is to evaluate the role of inferior turbinoplasty in the management of nasal obstruction in long standing allergic rhinitis. This study includes 80 patients with persistent allergic rhinitis presenting with longstanding nasal obstruction. Methods In the period from November 2017 to May 2019, 80 patients who were diagnosed with allergic rhinitis as per ARIA guidelines were studied. These patients were divided into two groups of 40 patients each. Group I /study group consisted of patients with persistent nasal obstruction associated with bilateral inferior turbinate hypertrophy and were willing to undergo bilateral inferior turbinoplasty. Group II or the control group consisted of patients with persistent nasal obstruction associated with bilateral inferior turbinate hypertrophy who were treated conservatively with additional nasal steroid spray and antihistamines for a further duration of 4 weeks. There were 4 follow up visits which were done after a week, after a month, at three months and 6 months duration. Results The age of the patients included in this study ranged from 19 to 58 years in both the groups.Majority of the patients were between 30 and 60 years in both the groups. In both the groups, female patients were 43% of the study population and males were 57%.Both of the groups are age and gender matched. At the end of 6 months of the study period, significant improvement in NOSE score was seen in both the groups (p value < 0.0001). However the intergroup comparison of NOSE score shows that those patients who underwent bilateral inferior turbinoplasty (GROUP I) had significantly lower NOSE scores when compared to those who were treated conservatively with medications (GROUP II). Conclusion Patients who underwent bilateral inferior turbinoplasty had better outcome with respect to nasal obstruction as compared to patients who had undergone conservative medical line of management with medications.

RATIONALE:Currently, hypokalemia is managed with potassium supplements; however, there are some rare cases where it can hint towards autoimmune diseases such as systemic lupus erythematosus (SLE). The purpose of this case is to bring attention to the diagnostic difficulty of SLE in the absence of typical mucocutaneous features. PATIENT CONCERNS:The symptoms included weakness and swelling of the legs. The patient's history revealed persistent chronic hypokalemia over a 4-year period, during which she was treated with potassium supplements, yet without any primary cause being identified. DIAGNOSES:A comprehensive evaluation found both hematological and renal abnormalities. Notably, despite the lack of classic dermatological signs of lupus, she scored 23 on the European League Against Rheumatism/American College of Rheumatology scoring system. She also screened positive for autoimmune disorders with a significant elevated antinuclear antibody profile including high lupus-specific autoantibodies. Subsequent bone marrow evaluation ruled out other hematological malignancies. Considering all the findings, she was diagnosed with SLE. INTERVENTIONS:She was treated with corticosteroid therapy, consistent with her diagnosis and forming part of the prescribed standard immunosuppressive treatment regimen. OUTCOMES:The patient demonstrated significant clinical improvement with regard to her symptoms and her potassium levels. She remained stable in further follow-up. LESSONS:This case illustrates the importance of very active investigation of the cause of persistent hypokalemia and a multidisciplinary collaboration. Autoimmunity should be considered in chronic electrolyte derangements, particularly in the presence of some blood or kidney problem. SLE is one of the conditions that can be diagnosed and treated early for better clinical outcome.

Introduction Multiple primary malignancies (MPMs) are increasingly being detected with improved survival and diagnostics. However, Indian data remain limited. This study evaluated the epidemiology of MPMs in a tertiary cancer center. Objective To analyze the clinicopathological profile, survival outcomes, and etiological factors of patients with MPMs at a South Indian cancer center. Materials and Methods This is a retrospective observational study of patients with MPMs analyzed between March 2023 and July 2025. Patients were identified using the Warren-Gates criteria. Data on demographics, tumor sites, histology, stage, treatment, and outcomes were collected. The overall survival (OS) was estimated using the Kaplan-Meier method. Results Sixty-five patients were included: 37 metachronous (56.9%), 27 synchronous (41.5%), and 1 triple primary (1.5%). The median age at diagnosis was 54 years for synchronous malignancy, while for metachronous cases, index cases are usually diagnosed at a median age 48 years and second primary cancer diagnosed on a median age of 51 years, with a median interval of 20 months. Male more common for synchronous, while female common in metachronous. Breast cancer was most common among metachronous index and second primary cases, and gastrointestinal tumors were predominant among synchronous cases, and adenocarcinoma was the most common histology. Molecular testing was performed whenever feasible. Index metachronous tumors were mostly nonmetastatic (86.5%), whereas second primaries metastatic (40.5%) burden was increased. Treatment completion was highest for first primaries (89%), followed by second (43%) and synchronous tumors (56%). The etiological links were mainly tobacco-related (45%) and genetic (35%). Median OS was 86.0 months for metachronous, 29.0 months for synchronous, and 10.0 months for triple primaries; overall cohort median OS was 43.0 months. Conclusions MPMs in this Indian cohort showed distinct patterns of breast and gastrointestinal predominance, limited molecular testing, and a survival advantage for metachronous disease. These findings support long-term surveillance, tobacco-control measures, and integration of genetic counselling and molecular profiling in low- and middle-income country settings.

Background:Sacral chordomas are rare malignant tumors arising from notochordal remnants that present unique surgical challenges due to their indolent growth, locally aggressive behavior, and high recurrence rates despite treatment. This review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances for sacral chordomas. Methods:This systematic review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances through analysis of PubMed, Scopus, and Web of Science databases [2023-2025]. Results:En bloc resection with wide negative margins remains the cornerstone of treatment, achieving optimal local control but often at the cost of significant neurological and functional morbidity. Modern reconstruction techniques, including vascularized grafts and three-dimensional (3D)-printed prostheses, have improved spinopelvic stability and postoperative outcomes. Adjuvant particle beam radiotherapy, particularly proton and carbon ion therapy, demonstrates superior 5-year local control rates of 77-89% compared to 10-30% with conventional photon therapy, while stereotactic radiosurgery achieves 81% local control. Systemic therapies remain limited, though targeted inhibitors of platelet-derived growth factor receptor (PDGFR), epidermal growth factor receptor (EGFR), and the PI3K/AKT/mTOR pathway show modest activity with disease stabilization in 60-70% of cases. Novel immunotherapeutic approaches, including Brachyury-targeted vaccines and checkpoint blockade, are under investigation. Molecular insights have identified key drivers, including Brachyury [T-box transcription factor T (TBXT)], receptor tyrosine kinases, and emerging biomarkers that may guide future therapeutic selection. Conclusions:Integrated multimodal care is critical for improving survival and function in patients with sacral chordomas.