Introduction: Contrast-Enhanced Mammography (CEM) is an emerging functional breast imaging technique that integrates digital mammography with intravenous iodinated contrast administration. Following the introduction of a dedicated Breast Imaging-Reporting and Data System (BI-RADS) lexicon for CEM in 2022, validation of individual Recombined (RC) image descriptors has become essential for standardised interpretation. Aim: To evaluate the distribution of CEM BI-RADS recombined image descriptors in malignant and non-malignant breast lesions. Materials and Methods: The present prospective observational study was conducted between July 2019 and March 2023 at the Institute of Radiodiagnosis, Government Kilpauk Medical College and hospital, Chennai, Tamil Nadu, India, and evaluated 802 breast lesions (327 malignant and 475 non-malignant) from 769 participants using CEM. RC image descriptors- including enhancement presence, morphology, margins, internal enhancement characteristics, distribution patterns, lesion conspicuity, and contrast kinetics- were assessed according to the 2022 American College of Radiology Breast Imaging-Reporting and Data System (ACR CEM BI-RADS) lexicon. Statistical analysis was performed using the Chi-square test, with p<0.05 considered statistically significant. Results: The study population comprised women, with malignant lesions predominantly observed in patients aged over 40 years (mean age: 52.68±10.61 years), while non-malignant lesions were more common in younger patients (mean age: 48.78±9.64 years). Absent enhancement was identified exclusively in non-malignant lesions (57.9%). A higher frequency of mass enhancement was observed in malignant lesions (83.5%) compared with non-malignant lesions (36.2%). With respect to mass enhancement patterns, non-circumscribed margins (86.4% vs. 12.2%), heterogeneous internal enhancement (74.7% vs. 25.6%) were observed in a significantly higher proportion of malignant lesions than non-malignant lesions. Similarly, malignant lesions demonstrated higher lesion conspicuity and predominantly washout (82.4%) or plateau (16%) contrast kinetics. Conclusion: According to the findings of the present study, distinct CEM BI-RADS recombined image descriptors demonstrate significant associations with malignant and non-malignant breast lesions.
Background: Obsessive compulsive disorder (OCD) can present with a wide range of symptom dimensions, including less commonly recognized taboo obsessions related to sexual orientation and gender identity. These presentations may lead to diagnostic confusion, particularly with gender dysphoria, especially in adolescents. Case description: We report the case of a 17-year-old male who presented with a 4-year history of intrusive, distressing doubts about being transgender. The thoughts were ego dystonic, repetitive, and associated with significant anxiety and functional impairment. The patient engaged in multiple compulsive behaviors, including mirror checking, genital checking, mental review of past behaviors, and repeated reassurance seeking. Mental status examination revealed preserved insight and absence of psychotic features. Careful clinical evaluation helped differentiate OCD-related gender identity obsessions from gender dysphoria. Management and outcome: The patient was treated with fluoxetine, titrated up to 60 mg/day, along with cognitive behavioral therapy (CBT) incorporating exposure and response prevention. Over 12 weeks, there was a significant reduction in symptom severity, with improvement in functioning and a decrease in Yale Brown Obsessive Compulsive Scale (YBOCS) score from 22 to 14. Conclusion: This case highlights the importance of recognizing gender identity-related obsessions as a subtype of OCD and differentiating them from gender dysphoria. Early identification and appropriate treatment can lead to favorable outcomes and prevent unnecessary interventions.
Salmonella enterica (S. enterica) is an important pathogen responsible for bloodstream infections, particularly in developing nations. These infections often lead to bacteremia, with a few patients developing cardiac complications in high-risk populations. Myocarditis, a common manifestation, presents with fever, chest pain, and dyspnea and can lead to severe complications, such as cardiogenic shock. Salmonella endocarditis, although rare, predominantly affects the mitral valve and leads to critical complications, including valve perforation and dehiscence, with a high mortality rate. Patients with purulent pericarditis present more acutely with toxic features. Arrhythmias, notably third-degree atrioventricular block and ventricular fibrillation, are prevalent complications primarily due to myocarditis. Diagnostic methods range from isolating Salmonella from clinical samples to immunoblotting and polymerase chain reaction-based assays that target specific genes. Depending on severity, treatment includes supportive care or antibiotic therapy with fluoroquinolones in uncomplicated cases and cephalosporins in complicated cases. Timely diagnosis and appropriate management strategies are crucial for mitigating the morbidity and mortality associated with S. enterica infections.
Background: Urothelial carcinoma of the bladder is a significant global cause of morbidity and mortality. These tumors are classified into low-grade and high-grade lesions based on architectural patterns, cytological features, and nuclear atypia. Muscle invasion remains a critical determinant in treatment planning and prognosis. Aims and Objectives: The aim of this study is to evaluate the immunohistochemical expression of human epidermal growth factor receptor 2 (HER2)/neu in urothelial carcinoma of the bladder and to correlate this expression with various clinico-pathological parameters. The objectives include analyzing the age-wise, gender-wise, and site-wise distribution of urothelial carcinoma; correlating histopathological grade with tumor stage; assessing the relationship between urine cytology and tumor grade; and evaluating HER2/neu expression in relation to age, gender, tumor size, grade, stage, and invasiveness to aid in patient management. Materials and Methods: This study was conducted in the Department of Pathology, Stanley Medical College and Hospital, Chennai, over 1 year (September 2024–September 2025). Immunohistochemical evaluation of HER2/neu was performed on biopsy-proven urothelial carcinoma cases. Prospective and retrospective data were analyzed, and HER2/neu expression was correlated with clinical and pathological variables, including age, gender, tumor size, grade, stage, and invasiveness. Results: Urothelial carcinoma showed a peak incidence above 50 years. Males constituted 69% of cases. The lateral wall was the most common tumor site. Urine cytology demonstrated higher sensitivity for high-grade tumors. High-grade carcinomas were predominantly stage II-III, whereas low-grade lesions were more often stage I-II. Conclusion: HER2/neu expression showed significant correlation with tumor grade but not with invasiveness, stage, age, gender, or size. Overexpression may indicate a poorer prognosis and potential eligibility for targeted therapy.
Abstract Introduction: Anterior shoulder instability is common among young, active individuals, with Bankart lesions present in the majority of cases. While arthroscopic Bankart repair is the current standard of care, the optimal number of suture anchors remains debated. This prospective study evaluated whether anchor number influences functional outcomes and recurrence rates over 2 years. Methods: A total of 100 consecutive patients undergoing arthroscopic Bankart repair for magnetic resonance imaging-confirmed Bankart lesions between December 2019 and December 2022 were included. Exclusion criteria were significant bone loss, multidirectional instability, rotator cuff tears, and connective tissue disorders. Repairs were performed by a single surgeon using two or more anchors, with remplissage added for engaging Hill–Sachs lesions. Functional scores (American Shoulder and Elbow Surgeons [ASES], Quick Disabilities of the Arm, Shoulder, and Hand [DASH], and ROWE), range of motion, and pain (visual analog scale [VAS]) were recorded preoperatively and at 1, 3, 6, 12, and 24 months. Outcomes were compared between patients receiving two anchors versus ≥3 anchors. Results: Mean age was 25.2 ± 7.1 years; 91% were male. Two anchors were used in 77% of cases. Remplissage was performed in 26%. At 2 years, mean VAS decreased from 5.0 to 0.8, ASES improved from 48.2 to 88.1, Quick DASH from 42.0 to 9.6, and ROWE from 50.9 to 92.4 ( P < 0.001). Range of motion improved significantly without clinically relevant external rotation loss. No recurrences or anchor-related complications occurred. Functional outcomes were equivalent between anchor groups and remplissage status. Conclusion: Our findings suggest that, in carefully selected patients without major bone loss, arthroscopic Bankart repair provides excellent early to midterm functional outcomes and stability, and that outcomes are not significantly influenced by the absolute number of suture anchors used.
