Objectives:Vitamin D deficiency is linked to rickets in children, precocious puberty in adolescents, polycystic ovarian syndrome in adults and osteoporosis in older adults. Its requirements for females differ according to the stages of life. This study aims to estimate the proportion of vitamin D deficiency in female patients at different stages of life. Materials and methods:This cross-sectional retrospective study was done on female patients undergoing vitamin D estimation from January to December 2024 in All India Institute of Medical Sciences, Raebareli, India.. Vitamin D estimation in serum was conducted on VITROS 5600 Immunodiagnostic Systems by chemiluminescence immunoassay technique. Serum levels of ≥30 ng/mL, 20-30 ng/mL and < 20 ng/mL were considered normal, insufficient and deficient, respectively. Data was collected in a Microsoft Excel spreadsheet and analysed by IBM SPSSv25. Results:Vitamin D estimation was done on 8 403 female patients. Deficient, insufficient and normal vitamin D levels were seen in 33.3%, 31.0% and 35.7% of subjects, respectively. Analysis according to the life stages highlighted that adolescents (13-18 years) had the highest (46.8%) deficiency, followed by young adults (19-24 years) (40.0%). Mean vitamin D levels were the lowest (24.2±15.9 ng/dL) in adolescents (13-18 years) and the highest (40.9±27.6 ng/dL) in newborns and babies (0-1.9 years) (F=22.8, p=0.00). Significant seasonal differences in vitamin D levels were observed, with the lowest (25.9±18.8 ng/dL) being seen in February and the highest (31.8±17.1 ng/dL) in August (F=7.1, p=0.00). Conclusion:Across the stages of life in female patients, adolescents (13-18.9 years) had the highest burden of vitamin D deficiency. Incorporating vitamin D supplementation under the national health programme for adolescent females will be beneficial.
Background:Bacillus Calmette-Guérin (BCG)-related complications, non-tuberculous mycobacteria (NTM) and classical tuberculosis (TB) are all examples of mycobacterial diseases. Accurate pathogen identification and host immunological state are essential for diagnosis and treatment. Case presentation:A four-month-old male child with disseminated BCG (Bacillus Calmette-Guérin) infection and TB as a result of STAT1 deficiency (Mendelian susceptibility to mycobacterial diseases MSMD) and a 17-year-old girl with a chronic cutaneous and soft tissue Mycobacterium abscessus infection are the two different examples that we describe. Granulomatous inflammation and acid-fast bacilli (AFB) were present in both individuals. The infant was awaiting hematopoietic stem cell transplantation after receiving extended antimycobacterial therapy but did not survive. Following the failure of initial empirical antitubercular treatment (ATT), the adolescent needed NTM-targeted combination therapy with clarithromycin, amikacin, and ethambutol. Conclusion:The need of careful clinical evaluation and ongoing diagnostic vigilance is underscored by the highlighted diagnostic problems. These instances show how unusual mycobacterial illness presentations might cause delays in diagnosis, especially in susceptible groups. Accurate diagnosis depends on confidence in complete diagnostic methods, which include thorough clinical examination, suitable imaging, microbiological testing and immunological assessment. This case series emphasizes how important it is to combine interdisciplinary skills in order to handle complex diagnoses, identify uncommon mycobacterial infections in a timely manner and direct efficient treatment plans, all of which improve patient outcomes.
Introduction:Low-grade fibromyxoid sarcoma (LGFMS) is a rare soft tissue neoplasm, typically located at the deep tissues of the trunk and extremities, that occurs mostly in the young adult age. Very few cases of children affected are reported in the literature, that interestingly tend to present with superficially sited tumors. Though benign in appearance, LGFMS can potentially behave as a malignant tumor with local recurrence or even distal metastases. Case description:We report a case of a six-year-old boy with a rare presentation of an asymptomatic superficial thoracic mass, that raised our suspicion due to its progressively enlarging size and when surgically excised it proved to be a LGFMS. Conclusion:This case raises awareness for atypical presentations of LGFMS in children with superficial growing lesions, which can be misdiagnosed and therefore maltreated. Complete excision and long-term surveillance are the main treatment components for the patients' safety, since the potential of malignancy cannot be ruled out in this type of tumor.
Urinary tract infections (UTIs) are common both in adults and particularly in children. It is estimated that the number of UTI cases has reached 4.49 billions in 2021, while common and often successfully treated with antibiotics UTIs pose the risk for sepsis, kidney complications and occurrence of antibiotic-resistant microbial strains. Symptoms of UTIs in children vary from non-specific, such as fever and lethargy, to specific such as difficult voiding, dysuria and suprapubic, abdominal or lumbar pain. Urinary tract infections may be lower (cystitis) or upper (pyelonephritis) and the etiological diagnosis is based on urinalysis and urine culture. There are several resistance mechanisms that commonly occur across different bacterial species (some of them being found in the same family) responsible for pediatric UTIs. For instance, an extensive mechanism of resistance is the production of beta-lactamase. Gram-negative bacilli may also develop polymyxin resistance; Staphylococcus aureus may become methicillin resistant and vancomycin resistance may appear in both S. aureus and Enterococcus spp. The present review presents the mechanisms of resistance of bacteria involved in UTIs in children.
Introduction: Continuous positive airway pressure (CPAP) therapy is the main therapeutic method for obstructive sleep apnea syndrome (OSAS). The way of accommodating the patient with the CPAP mask is very important for adherence to therapy. In this study, we tried to determine the patient-reported causes for suboptimal use of CPAP therapy and to draw up some recommendations for their management, with the aim to improve adherence to CPAP therapy. Materials and methods: The present study investigated 86 patients diagnosed with OSAS who were divided into two categories by CPAP adherence (at least four hours per night therapy in at least 70% of the recommended days): CPAP adherent patients (n = 50) and non-adherent patients (n = 36). All participants completed a questionnaire to report the side effects of therapy and the main reasons for suboptimal use of CPAP therapy. Results: The reported causes for the inappropriate use of therapy with statistical significance included side effects of the mask and device, misperception of disease severity and lack of confidence that CPAP therapy is useful for treating OSAS. Dry mouth, the main side effect reported by both adherent and non-adherent patients, was not a predictor of statistical significance for adherence to therapy. Suboptimal use of therapy, a statistically significant factor for adherence to treatment, occurred in some of the OSAS patients who developed anxiety related to CPAP device. Many non-adherent participants used an air humidifier attached to CPAP to treat dry mouth as a side effect, which did not help increase adherence in this group of patients. Conclusion: Multiple factors may be involved in OSAS patients' adherence to CPAP therapy. Of these, side effects in therapy can play an important role and resolving them can be an essential factor for patient adherence.
Background:Identifying hereditary breast cancer is increasingly important, as germline pathogenic variants not only influence lifetime cancer risk but also guide surveillance, preventive strategies and targeted treatments. While breast cancer genes (BRCA1 and BRCA2) remain central to hereditary breast and ovarian cancers, progress in cancer genetics has shifted clinical practice toward broader multigene testing approaches. Methods:We reviewed the recent literature on the molecular basis of hereditary breast cancer, current genetic testing strategies, guideline-based indications, and the psychological, ethical and social challenges of genetic risk disclosure. Results:Next-generation sequencing (NGS)-based multigene panels enable the efficient identification of high- and moderate-penetrance variants, supporting personalized screening, risk-reducing interventions and treatment selection, including eligibility for enzyme poly ADP ribose polymerase (PARP) inhibitors. However, clinical implementation remains limited by persistent barriers, such as variants of uncertain significance and unequal access to genetic counselling and testing services. Conclusions:Genetic testing is reshaping breast cancer care by bridging prevention and precision oncology. Improving access, strengthening counselling pathways and optimizing variant interpretation are essential steps to ensure that genomic advances translate into real-world clinical benefits.
Background: Meditation is the practice of focusing the mind on a particular object, thought, or activity to reach a calm, stable state. Meditation is been practised since ancient past in various forms. Transcendental meditation (TM) is widely practiced for its potential benefits on mental and physical well-being using the mantra "OM" as an object of awareness. Despite its popularity in the Global North, evidence of its impact on cognitive and psychological health remains limited in the Indian context. Aim: To evaluate the effects of TM practice on cognitive performance by audiovisual reaction time and psychological parameters. Methods: This single-group quasi-experimental study was conducted after Institutional Ethics Committee approval. Thirty-four volunteers (13 males and 21 females aged 25-50 years) underwent a 12-week TM intervention from a certified instructor. Audiovisual reaction time was measured using a Psychotronics digital reaction time apparatus and ADI Power Lab 8. The Profile of Mood States (POMS), Pittsburgh Sleep Quality Index (PSQI) and Standardized Assessment of Personality Abbreviated Scale (SAPAS) were used for psychological assessment. Resilience was measured using the Nicholson McBride Resilience Questionnaire (NMRQ). Data were analyzed using SPSS version 29. Results: Audiovisual reaction time was significantly reduced as a result of TM for cognitive tasks suggesting enhanced cognitive processing speed. Highly significant improvements were also observed in mood scores, sleep quality, resilience levels after the TM intervention (p<0.0001). Personality traits showed an increase in positive scores toward emotional stability. Conclusion: Transcendental meditation improves cognitive performance and psychological well-being, supporting its potential as a complementary approach for mental health promotion and stress reduction. It can also be utilized for enhancing focus and attention, in activities demanding rapid and accurate responses, such as sports.
Background:Ophthalmic emergencies constitute a significant portion of emergency department (ED) visits; yet, many non-ophthalmologists report feeling underprepared for their management. In Lebanon, mass-casualty events like the 2020 Beirut Port Blast have further highlighted the critical need for structured assessment of personnel preparedness in managing ocular trauma. This study aimed to evaluate the validity and reliability of a novel questionnaire designed to measure the self-reported preparedness and confidence of ED personnel and first responders in managing acute ocular emergencies. Methods:A cross-sectional validation study was conducted among 431 Lebanese ED healthcare providers and first-line responders, primarily paramedics (69.6%). The 10-item Likert scale instrument underwent expert review for content validity. Psychometric evaluation included internal consistency reliability (Cronbach's α and McDonald's ω) and construct validity via exploratory factor analysis (EFA). Results:The instrument demonstrated high internal consistency (Cronbach's α = 0.922; McDonald's = 0.924) and strong sampling adequacy (KMO = 0.910). EFA supported a clinically interpretable two-factor structure: "Trauma-Specific Stabilization and Escalation Confidence" and "General Emergency Preparedness in Ophthalmology". Participants reported the lowest confidence in medication indications (mean = 2.53) and training adequacy (mean = 2.62). Conclusion:The questionnaire is a valid and reliable tool for assessing self-reported preparedness in ophthalmic emergency management. It can serve as a standardized benchmarking instrument to identify educational gaps and guide training interventions in high-throughput, resource-constrained acute care settings.
Objectives:Cutaneous melanoma (CMM) is an aggressive malignancy whose incidence continues to rise worldwide. Ultraviolet (UV) radiation from natural and artificial sources is a major environmental risk factor and is classified as a Group 1 carcinogen by the International Agency for Research on Cancer. The present study aimed to evaluate the association between sun exposure patterns and the clinicopathological characteristics of patients with cutaneous melanoma, focusing on tumor thickness and markers of tumor aggressiveness. Materials and methods:This retrospective cohort study included 115 patients with histologically confirmed primary cutaneous melanoma treated in our Plastic Surgery Department between January 2018 and December 2022. Demographic, clinical and histopathological data were collected from medical records and Breslow thickness was categorized as thin (≤2 mm) or thick (>2 mm). Statistical analysis included chi-square and Mann-Whitney U tests, followed by multivariate logistic regression to identify predictors of increased tumor thickness. A p-value < 0.05 was considered statistically significant. Results:Statistically significant associations were identified between several clinicopathological variables and melanoma characteristics. Sun exposure pattern was significantly associated with tumor anatomical location [χ²(6) = 85.11, p < 0.001], with chronic exposure predominantly linked to melanomas of the posterior trunk, while intermittent exposure was more frequently observed in melanomas of the lower limbs. Patients with thick melanoma were significantly older than those with thin tumors (p = 0.032). Melanoma thickness was also significantly associated with histological subtype (p = 0.002), ulceration (p < 0.001), and mitotic activity (p = 0.002), with nodular melanoma, ulcerated tumors, and lesions with increased mitotic activity more frequently presenting greater Breslow thickness. Metastatic disease occurred more often in patients with thick melanomas (p = 0.046). In multivariate analysis, mitotic activity remained an independent predictor of thick melanoma [OR = 1.75, p < 0.001], while ulceration showed borderline significance (odds ratio [OR) = 4.14, p = 0.050]. Overall, sun exposure pattern was associated with melanoma location but not with markers of tumor aggressiveness. Conclusion:Sun exposure pattern was associated with melanoma anatomical location but not with tumor aggressiveness. Increased mitotic activity was the strongest independent predictor of thick melanoma, while ulceration showed borderline significance. These findings suggest that intrinsic tumor characteristics play a greater role in melanoma progression than sun exposure patterns.
Background:Pulmonary hypertension (PH) is highly prevalent in patients with chronic kidney disease (CKD) and is a strong predictor of mortality. The relative contributions of vascular access for hemodialysis (HD) in the pathogenesis of PH remain under debate. This study analyses the prevalence and potential predictors of PH in End-stage renal disease (ESRD). Material and methods:A retrospective cross-sectional study of 51 CKD patients on maintenance dialysis (86% HD, 14% peritoneal dialysis (PD)) was conducted. Patients underwent comprehensive echocardiography to estimate systolic pulmonary artery pressure (SPAP). Pulmonary hypertension was defined as SPAP > 35 mm Hg. The associations between SPAP and vascular access type, arteriovenous fistula (AVF) location and echocardiographic parameters were analyzed using univariate and multivariable linear regression models. Results:The prevalence of PH was 31% and the median SPAP was 30 mm Hg. There was no significant difference in SPAP between patients with central venous catheters, proximal AVFs or distal AVFs. Left atrial volume was the strongest independent predictor of SPAP (beta = 0.41, p < 0.001). Elevated E/e' ratio (p = 0.002) and reduced left ventricular ejection fraction (p = 0.016) were significantly associated with SPAP in univariate analysis. PD patients exhibited significantly smaller left atrial volumes compared to HD patients (p = 0.023). Conclusions:Pulmonary hypertension is frequent in ESRD. The main drivers of PH in ESRD are volume overload and left heart disease. These findings support volume management as the primary therapeutic target for PH in the dialysis population.
Introduction:Type 2 diabetes mellitus (T2DM) is a rapidly growing public health challenge in India, driven by urbanization, lifestyle transitions and increasing obesity. Early identification of associated cardiometabolic risk factors is essential to reduce complications and improve disease outcomes. Objectives:To assess the prevalence of diabetes and prediabetes and to evaluate associated clinical and socioeconomic risk factors among patients attending a tertiary care center in North India. Methods:This cross-sectional study included 696 participants who were evaluated for glycemic status, anthropometric measurements, blood pressure and comorbidities. Diabetes and prediabetes were classified according to standard guidelines. Obesity was defined using Asian-specific body mass index (BMI) cut-offs and hypertension was categorized based on established criteria. Sociodemographic and clinical data were collected using structured questionnaires. Statistical analysis was performed using appropriate comparative tests, with p<0.05 being considered statistically significant. Results:Among the study population, 89.08% of subjects had diabetes and 10.92% prediabetes. Overweight and obesity were observed in 31.88% and 19.34% of participants, respectively. Hypertension was highly prevalent, with 34.52% of subjects being classified as Stage 2 and 17.96% Stage 1 hypertension. A positive family history was reported in 23.85% of cases. Most patients had a disease duration of less than five years (56.32%). The clustering of obesity, hypertension and diabetes indicated a significant cardiometabolic overlap. Conclusion:The study highlights a substantial burden of diabetes and its associated modifiable risk factors in a North Indian population. Strengthening early detection strategies, lifestyle modification programs and integrated management approaches is essential to reduce long-term complications and improve public health outcomes.
Objectives:Low and subnormal anion gap (AG) values are frequently overlooked in clinical practice despite potential diagnostic and prognostic implications. We aimed to characterise the distribution of AG and albumin-corrected anion gap (CAG) in a large multicentre cohort of critically ill patients, quantify the prevalence of low and subnormal values and examine AG behaviour in the presence of clinically significant lactic acidosis. Materials and methods:We performed a retrospective secondary analysis of the publicly available Blood Gas and Oximetry Linked Dataset (BOLD), comprising de-identified records from MIMIC-III, MIMIC-IV and eICU-CRD databases. Anion gap and CAG were calculated, with CAG being adjusted for albumin. Low AG was defined as <6 mmol/L, subnormal as 6-10 mmol/L and elevated as >16 mmol/L. Clinically significant lactic acidosis was defined as lactate >5 mmol/L. Mortality differences were assessed using Pearson's chi-square test. Results:Among 37,763 admissions with available AG data, AG was less than 6 mmol/L in 1.6% of patients and <10 mmol/L in 15.3% of subjects. After albumin correction, CAG was less than 6 mmol/L in 0.5% of patients and <10 mmol/L in 5.8% of subjects. In the subgroup with lactate >5 mmol/L, 19.2% of patients did not have an elevated AG and 8.2% did not exhibit an increased CAG. Among patients with normal or low CAG values, in multivariable logistic regression adjusting for age, pH, albumin, SOFA score and comorbidity index, clinically significant lactic acidosis remained independently associated with mortality [adjusted odds ratio (OR) 3.05, 95% confidence interval (CI) 2.04-4.56]. Conclusions:Low and subnormal AG values are relatively common in critically ill patients even after albumin correction and the causes remain unclear. A substantial proportion of patients with clinically significant lactic acidosis do not exhibit an elevated AG. Clinicians should exercise caution when using AG to categorise metabolic disorders, as high-anion-gap physiology may be masked by an underlying low or subnormal anion gap.
Introduction:Cervical carcinoma is a leading cause of female malignant-depended morbidity and mortality worldwide. Although modern gynecological screening, including Papanicolaou (PAP) test and human papillomavirus (HPV) DNA/m RNA tests, provides an optimal management in female health, there is an increasing need for understanding the role of specific molecular pathways implicated in the disease. Among them, apoptosis plays a crucial role in the progression of the malignancy and also in the response rates to chemo-targeted therapeutic regimens. Objective:The purpose of the current molecular review was to explore the role of mitochondrial-based anti-apoptotic and apoptotic pathways in cervical carcinoma molecular substrate and their established and also potential chemo-targeted inhibitors. Material and method:A systematic review of the literature was carried out based on the international database PubMed including 50 significant papers in the examined scientific field. The following keywords were used: apoptosis, mitochondria, cervical, carcinoma, B-cell lymphoma. Results:B-cell lymphoma (BCL) proteins' expression in cervical carcinoma demonstrates differences among the corresponding patients. Especially, overactivation of BCL-2 seems to lead in an aggressive cervical carcinoma phenotype (advanced stage, poor prognosis) due to its strong anti-apoptotic action. Conclusions:Mitochondria play a crucial role in the apoptotic phenomenon regarding cervical carcinoma. BCL-2 overexpression induces the resistant to normal apoptotic signalling pathway leading to an immortalization-like status of the malignant cells. This event is crucial for the survival and response rates in the patients with BCL-2 abnormal activity. Furthermore, it seems that high risk HPV types activate BCL-2 by the increased oncogenic influence of E6/E7 viral genes. For these reasons, a broad spectrum of anti-BCL-2 inhibitors is under experimental, basic research and clinical evaluation regarding cervical carcinoma patients.
Background:The integration of bone grafts is a determinant factor for achieving the success of implants and the outcome of healing is hard to predict. Artificial intelligence (AI) holds potential in the cone-beam computed tomography (CBCT) image analysis to predict regenerative outcomes. The purpose of the present study was to create and test a deep learning model to engage the success of bone graft integration in the case of simulated peri-implant defects in CBCT datasets. Methods:We conducted a retrospective study based on data of 847 CBCT scans of patients who experienced loss of soft tissues around the implant due to bone grafting operations. The 12-month radiographic and clinical outcomes have been used to classify defects into successful (n=512) and unsuccessful integration (n=335). ResNet-50 built on transfer learning was proposed as a convolutional neural network (CNN). The data were separated into training (70%), validation (15%) and testing (15%) sets. The performance of the models was compared in terms of accuracy, sensitivity, specificity, area under the receiver operating characteristic curve (AUC-ROC) and F1-score. Results:The AI model had an overall accuracy of 87.3 ± 2.1, a sensitivity of 89.6 ± 1.8, a specificity of 84.2 ± 2.4 and an AUC-ROC of 0.912 ± 0.023. It was found that defect morphology classification had a high predictive ability and circumferential defects exhibited a better prediction ability (91.2) than dehiscence-type defects (82.7) (p <0.01). The model showed better results than clinical assessment (87.3% vs. 71.4% p<0.001). Conclusion:The created AI model exhibits strong predictive power of bone graft integration success based on CBCT scans, which could provide a means to plan the treatment individually and make more effective clinical decisions in the field of implant dentistry.
Background:Periapical lesions pose a serious diagnosis problem in endodontics and there is high inter-observer variability in the conventional interpretation of radiographs. It has a solution in artificial intelligence (AI) technologies, which will improve the accuracy and consistency of diagnosis. This paper set out to determine the diagnostic accuracy of an AI system based on deep learning in identifying periapical lesions in endodontic radiographs as compared to clinical assessment and histopathological confirmation by an expert. Methods:A retrospective diagnostic accuracy study on 1,247 periapical radiographs of patients who had endodontic treatment or periapical surgery with histopathological verification was done. The architecture of a convolutional neural network (CNN) with EfficientNetB4 was trained using 80% of the dataset, where 10% was to be used as a validation and 10% as a test set. The diagnostic performance was assessed against the histopathological findings as the reference standard. The same radiographs were independently evaluated by three experienced endodontists. Sensitivity and specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) as well as area under the receiver operating characteristic curve (AUC-ROC) were determined. Results:The AI model had a total accuracy of 91.2 [standard deviation (SD) 1.7], a sensitivity of 93.4 (SD 1.5) and a specificity of 88.6 (SD 2.1). Endodontists had an average of 78.6 ± 4.3, which was highly lesser than the AI model (p <0.001). Agreement among clinicians (between different observers) was moderate (0.612). The AI model was superior in all categories of lesion sizes, showing significant improvement in cases of small lesions (less than 3 mm), with an accuracy of 87.8 compared to that of clinicians (64.2) (p<0.001). Conclusion:The model of AI built has shown better accuracy in detection of periapical lesions when compared with expert clinical assessment, especially when small lesions were involved. Such AI-based diagnostic tools may be important in facilitating endodontic diagnosis and treatment planning.
Introduction: Motor vehicle collisions, violence between individuals, falls, sports-related accidents and firearm injuries are frequent causes of maxillofacial trauma, which is a significant public health concern. Alcohol intoxication and a lack of use of protective gear are two factors that are known to raise the risk and complexity of these injuries. Despite its clinical and societal impact, region-specific data on the distribution of maxillofacial trauma by anatomical site and etiology in Manipur, India, remain limited. This observational investigation was conducted to determine the patterns of maxillofacial fractures in terms of anatomical location and causative factors, identify the prevalence of protective equipment usage and explore the relationship between alcohol consumption and the etiology, anatomical site and severity of facial injuries. Methods: A prospective observational study was conducted over a two-month period at tertiary care hospitals in Manipur, enrolling 44 patients with radiographically confirmed maxillofacial trauma. Data on demographic characteristics, clinical presentation and imaging findings were systematically collected. The severity of facial injuries was assessed using the AIS-90 facial injury scale. Association between alcohol intoxication and various injury parameters were analyzed using the Chi-square test (p value < 0.05). Results: Males constituted the predominant proportion of patients (84.1%), with a mean age of 31.1 years. Fractures of the mandible were most common (50%), followed by dentoalveolar (15.9%) and midfacial fractures (11.4%). Road traffic accidents (RTAs) were the predominant cause (61.4%), followed by assault (13.6%) and accidental falls (9.1%). Only 2.3% of patients reported using protective gear at the time of injury. Alcohol intoxication was observed in 40.9% of cases and was significantly associated with RTAs (p value <0.05), fracture site (p value < 0.005) and severity (p value < 0.05). Conclusion: Motor vehicle collisions were identified as the leading cause of maxillofacial injuries, with alcohol intoxication and inadequate use of protective equipment markedly increasing both the risk and severity of trauma. Enforcement of helmet and seatbelt regulations, public awareness on alcohol-related risks and promotion of protective gear use are essential to reduce maxillofacial injuries in the region.
Background:Epilepsy may cause sudden death. More scenarios are possible: sudden unexpected death in epilepsy (SUDEP), cardiac and non-cardiac mechanisms of death. This study presents the case history of a 57-year-old person known for epilepsy who experienced a final tonic-clonic seizures with ictal cardiorespiratory arrest shortly after hospital admission. The present study aimed to determine 1) the cause of death and possible mechanisms; and 2) reference values for immunoassays at 36.8-hour postmortem interval. Materials and methods:A full medico-legal autopsy was performed. Postmortem findings and a large panel of investigations are provided: anatomic pathology, pericardial chemistry investigations, forensic serology and toxicology. Immunoassays including sodium dodecyl sulfate-polyacrylamide gel electrophoresis (SDS-PAGE) with Western blotting for vinculin and enzyme-linked immunosorbent for cardiac TnT, vinculin and desmin were used to assess the postmortem interval. Results:Cause of death, mechanisms and medico-legal causality are debated. Autopsy findings and relevant investigations did not reveal a single identifiable cause of death incompatible with life. Even more, SUDEP appears improbable and status epilepticus not documented. An ictogenic cause of death with autogenous and cardiac mechanisms involvement, enhanced by concomitant conditioning factors, a severe metabolic acidosis, respiratory failure with impaired ventilation and extensive myocardial fibrosis appears more probable. SDS-PAGE with Western Blot was able to detect the native molecular band 117 kD of vinculin and three molecular products of degradation at 90 kD, 87 kD, 84 kD at 36,8-hour postmortem interval and therefore confirmed the postmortem interval, while ELISA detected cardiac TnT (178.85 pg/mL), vinculin (570.96 pg/mL) and desmin (565.77 pg/mL) in the skeletal muscle. Conclusions:This case highlights the important role played by medico-legal autopsy in death investigation in epilepsy. If for legal purpose causality is required, causes of death and conditioning factors are to be extensively investigated and connected. ELISA delivered benchmarks references at 36.8-hour postmortem interval and provided to be a valuable immunoassay method in estimation of postmortem interval.
Background:Androgen-secreting adrenal tumors are rare causes of virilization in adult women and often raise concerns regarding malignancy, particularly when tumor size exceeds 6 cm. Current guidelines recommend surgical resection in hormonally active adrenal masses, with minimally invasive surgery increasingly adopted in selected cases. Case report:We report the case of a 50-year-old woman presenting with progressive virilization due to a right adrenal mass measuring 10 cm. Hormonal evaluation revealed marked androgen excess, with elevated serum testosterone, androstenedione and dehydroepiandrosterone sulfate levels. Imaging studies showed a well-defined adrenal lesion without radiological signs of local invasion. The patient underwent robot-assisted laparoscopic adrenalectomy (RALA). The postoperative course was uneventful, with complete resolution of virilizing symptoms and normalization of androgen levels. Histopathological examination confirmed a benign androgen-secreting adrenal adenoma. Conclusion:This case demonstrates that robot-assisted laparoscopic adrenalectomy is a safe and effective treatment option for large, hormonally active adrenal tumors in carefully selected patients. Robotic surgery offers the benefits of minimally invasive approaches while maintaining oncological safety, supporting its role in guideline-concordant management of complex adrenal lesions.
Introduction:This study sought to assess the effectiveness of intraoral hyaluronic acid (HA) gel in alleviating postoperative pain, oedema and trismus after mandibular third molar surgery, and its capacity to reduce the need for non-steroidal anti-inflammatory drugs (NSAIDs). Materials and methods:This split-mouth study included 33 healthy patients aged 18 to 45 years with bilaterally impacted mandibular third molars who came to the Department of Oral and Maxillofacial Surgery, MES Dental College, Perinthalmanna, India, between November 2023 and March 2025. In the experimental procedure, 0.2% HA gel was applied to the extraction socket, while the control side did not receive any HA gel after surgical extraction. Postoperative evaluations of pain, oedema and trismus were documented on days 3 and 7 for both groups. Results:The use of HA markedly decreased pain perception during the initial postoperative period. However, trismus and the degree of oedema did not differ statistically significantly between the experimental and control groups. Conclusion:The intraoral application of HA gel after mandibular third molar surgery demonstrated analgesic effects and reduced the need for NSAID use.
