ERA's Lucknow Medical College

Tuberculum sellae meningioma (TSM) causes disproportionate vision loss due often to an associated bony hypertrophy or an intradural tumor invasion into the optic canals. Several surgical approaches are available for resecting the TSMs. A contralateral transcranial approach from the side of better/normal vision may be beneficial in asymmetrical TSMs. It allows a favorable angle of attack and access to the medial wall of the affected optic canal. Here, the authors demonstrate the technique of a contralateral supraorbital eyebrow approach (c-SOA) that could be useful in a specific subset of TSMs with good oncological and cosmetic outcome. The video can be found here: https://stream.cadmore.media/r10.3171/2025.10.FOCVID25166.

Acroangiodermatitis of Mali or pseudo-Kaposi sarcoma is a benign vascular condition associated with underlying vascular anomalies that affects the lower limbs with purple patches or nodules. A young male presented with varicosities and pedal oedema in both legs for several years, subsequently developing ulcerated nodules over his right leg. Upon clinical and histopathological evaluation, he was diagnosed with acroangiodermatitis of Mali on his right leg, associated with underlying chronic venous insufficiency in both legs. The patient showed remarkable improvement following treatment with compression bandages and lesion debridement. This case is noteworthy due to its rarity in the younger population and its unilateral manifestation.

Background: Small airway dysfunction (SAD) is increasingly recognized as an early pathological feature in chronic respiratory diseases such as asthma and chronic obstructive pulmonary disease. Conventional spirometry often fails to detect subtle abnormalities in patients with chronic respiratory symptoms and preserved ratio impaired spirometry (PRISm). Impulse oscillometry (IOS), a non-invasive technique performed during tidal breathing, offers a sensitive alternative for evaluating peripheral airway involvement. Aims and Objectives: This study primarily evaluated the role of IOS in detecting SAD among subjects with chronic respiratory symptoms and PRISm. A secondary objective was to compare spirometry with IOS in identifying SAD. Materials and Methods: An observational study was conducted among 132 adults with chronic respiratory symptoms, preserved forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) (≥0.70), and negative airway hyper-responsiveness or bronchodilator reversibility. IOS parameters, including R5, R20, X5, Fres, and AX, were measured and compared with spirometric indices (forced expiratory flow [FEF]25–75%, FEF50%, FEF75%). The diagnostic yield of IOS in detecting SAD was assessed. Results: The prevalence of SAD was 21.2% (28/132). Spirometry showed significant post-bronchodilator improvements in FEV1, FVC, and FEV1/FVC (P<0.001). IOS demonstrated significant changes in R5, R20, AX, Fres, and X5 (P<0.05), with R5–R20 and AX particularly sensitive to peripheral airway dysfunction. IOS identified abnormalities in symptomatic individuals despite preserved spirometry, correlating with clinical symptoms such as breathlessness and loss of appetite. Conclusion: IOS is a valuable adjunct to spirometry for detecting SAD in PRISm patients. It bridges the gap between subjective symptoms and objective measurements, enabling earlier diagnosis and intervention in chronic airway disease.

Background: Proton pump inhibitors (PPIs) are widely prescribed for the management of acid-related gastrointestinal disorders. Emerging evidence suggests that prolonged PPI therapy may adversely affect calcium and vitamin D metabolism, potentially increasing the risk of skeletal complications. Aim: To evaluate serum vitamin D and calcium levels among chronic PPI users and determine their relationship with duration of therapy. Methods: A hospital-based cross-sectional observational study was conducted among 100 participants comprising 50 chronic PPI users and 50 age- and sex-matched healthy controls. Serum 25-hydroxyvitamin D [25(OH)D] concentrations were measured using chemiluminescent immunoassay, while serum calcium levels were estimated using laboratory autoanalyzer based on spectrophotometric estimation . Group comparisons were performed using independent sample t-tests and chi-square tests. Pearson correlation analysis was used to assess associations between duration of PPI therapy and biochemical parameters. Results: Mean duration of PPI therapy was 24.34 ± 7.95 weeks. Serum vitamin D levels were significantly lower among PPI users compared with controls (18.4 ± 5.2 vs. 26.7 ± 6.1 ng/mL, p<0.001). Serum calcium levels were also significantly reduced in PPI users (7.92 ± 1.07 vs. 8.61 ± 0.52 mg/dL, p<0.001). Duration of therapy demonstrated a moderate negative correlation with vitamin D levels (r = −0.42, p = 0.002) and a weak negative correlation with serum calcium levels (r = −0.31, p = 0.028). Conclusion: Chronic PPI therapy is associated with lower serum vitamin D and calcium concentrations. Longer duration of therapy may further exacerbate these deficiencies, highlighting the need for periodic monitoring in long-term users.

Background: Shoulder pain is a common musculoskeletal complaint with diverse etiologies, necessitating accurate diagnostic approaches. The current study evaluates the role of clinical examination in conjunction with ultrasonography (USG) in diagnosing a painful shoulder. Aims and Objectives: The primary objective was to determine the causes of shoulder pain identified through clinical examination and correlate them with USG findings. The secondary objective was to compare the diagnostic accuracy of clinical examination with high-resolution USG in assessing shoulder pathologies. Materials and Methods: The study included 90 patients aged 18–75 years presenting with shoulder pain at the Orthopedics Outpatient Department of Hind Institute of Medical Sciences, Barabanki, Uttar Pradesh. Clinical assessment included inspection, palpation, and various functional tests, while USG utilized a 7.5 MHz linear phased array transducer to evaluate the rotator cuff, biceps tendon, and subacromial-subdeltoid bursa. Results: The majority of patients belonged to the 41–60 age group, with a nearly equal gender distribution. Clinical examination identified rotator cuff pathology as the most common condition (26.7%), followed by impingement syndrome (23.3%). USG demonstrated higher diagnostic accuracy, particularly for rotator cuff tears (90.5% sensitivity, 91.5% specificity) and supraspinatus tendinopathy (89.0% sensitivity, 92.5% specificity). Impingement syndrome (24.4%) and adhesive capsulitis (17.8%) were the most prevalent diagnoses. The findings reinforce the complementary roles of clinical examination and USG in achieving precise diagnoses. Conclusion: Clinical exam plus ultrasound improves shoulder diagnostics. Clinical assessment is a practical first-line screen, while ultrasound offers higher sensitivity and specificity for soft tissue lesions. Their integration enhances accuracy and guides effective patient management.