Papillary thyroid carcinomas (PTC) are the most common thyroid tumours that usually have a good prognosis. Recurrence, metastases, and cancer death may occur in a few patients and are more commonly associated with more aggressive tumours, such as tall cell, columnar cell, diffuse sclerosing variants and the rare hobnail variant of PTC. We present the clinicopathologic and immunohistochemical features of a rare aggressive variant of the PTC showing prominent hobnail features. A 68 year old male patient presented with swelling over the neck and change in voice of 5 months duration. USG and CECT revealed large hypodense enhancing nodule measuring 2.9x2.7x.3.7 cm (APxTRxCC) epicentered at superior aspect of right lobe of thyroid gland. Preoperative diagnosis with fine-needle aspiration (FNA) of right thyroid nodule was opined as Bethesda category V suspicious for Papillary Thyroid Carcinoma (PTC). Histopathological sections of right lobe of thyroid showed features of Hobnail variant of papillary Thyroid carcinoma with presence of tumour arranged in arborising papillary architecture with fibrovascular cores. More than 30% of lining cells had nuclei at the surface and showed hobnailing. This case is reported for its rarity and association with aggressive behaviour thus mandating awareness about this entity amongst all clinicians, pathologists and patients so as to enable early diagnosis, treatment and prognostication.
Background and Objectives: Non-communicable diseases (NCDs), including cardiovascular diseases, respiratory disorders, diabetes, and cancer, are leading causes of global morbidity and mortality. While lifestyle factors are well-recognized contributors, environmental exposures, particularly air pollution, are increasing implicated in NCD pathogenesis. This systematic review and meta-analysis evaluate the association between air pollution exposure and NCD risk. Materials and Methods: A comprehensive literature search was conducted in PubMed, Embase, Scopus, Web of Science, Google Scholar, and Cochrane Library for studies published between January 2015 and December 2024. Eligible studies included epidemiological research assessing exposure to major air pollutants – PM2.5, PM10, O3, NO2, NOx, SO2 and CO, and their association with NCDs. Statistical analysis was performed using RevMan 5.4, with pooled effect sizes expressed as mean differences (MD) or odds ratio (OR) with 95% confidence intervals (CI). Heterogeneity was assessed using the I2 statistic. Results and Interpretation: A total of 12 studies involving 7,43,083 patients met inclusion criteria. The meta-analysis showed a significant association (P<0.0001) between NCDs and without NCDs (OR: 0.05, 95% CI: 0.01–0.21), I2= t100% heterogeneity present among the studies. Meta-analysis showed significant associations between PM2.5 [MD:0.35(95%CI:0.11–0.59), P=0.005], PM10 [MD:0.66(95% CI:0.17–1.16), P=0.008], NO2 [MD:0.56(95%CI:0.15–0.97), P= 0.007] and CO [MD:4.13(95% CI:1.25-7.01), P=0.005] with increased NCD risk. High heterogeneity (I2>90%) was noted in PM2.5, PM10, NO2, O3, and SO2 air pollutants except NOx, CO. No significant differences were found for O3, NOx, and SO2. Conclusion: This study highlights a strong association between PM2.5, PM10, NO2, and CO exposure and increased NCD risk. While O3, NOx, and SO2 showed weaker associations, findings stress reducing air pollution. Significant heterogeneity underscores the complexity of health impacts, emphasizing the need for context-specific public health interventions.
Congenital anomalies of the gallbladder, such as the bilobed gallbladder (vesica fellea divisa), are rare clinical entities with an estimated incidence of 1 in 4,000 live births. These variations pose significant intraoperative challenges, particularly when compounded by a "frozen abdomen" from previous surgical interventions. We report a unique case of a 30-year-old male with a history of open surgery for hepatic hydatid disease who presented with recurrent right hypochondrium pain and vomiting. Preoperative imaging identified a large splenic hydatid cyst and cholelithiasis. While the splenic cyst was managed laparoscopically after insertion of the first trocar via Palmer’s point to avoid suspected adhesions, the gallbladder surgery required conversion to an open approach due to dense, matted adhesions at the gallbladder bed. Intraoperatively, a rare vesica fellea divisa (Boyden’s type) was discovered, containing multiple calculi in both lobes but draining into a single cystic duct. A total cholecystectomy was successfully performed. Histopathological examination confirmed a splenic hydatid cyst and chronic cholecystitis with no evidence of malignancy. The patient remained asymptomatic and expressed high satisfaction at his six-month follow-up. This case underscores the rarity of splenic hydatidosis and the critical need for surgical flexibility and meticulous anatomical delineation when encountering unexpected congenital biliary anomalies in a re-operative surgical field.
Suicide in India presents a complex public health challenge characterized by rising rates and pronounced regional disparities, particularly affecting young adults. The multifactorial determinants span psychological, social, economic and cultural domains, necessitating a comprehensive investigation. This study aimed to examine temporal trends, regional variations, demographic patterns, and psychosocial impacts of suicide in India to inform tailored prevention and support strategies. A secondary analysis of National Crime Records Bureau suicide data (2020-2023) was conducted alongside an integrative literature review of peer-reviewed epidemiological and qualitative studies. Quantitative and qualitative data were triangulated to explore suicide’s multifaceted effects, considering methodological limitations such as underreporting and data heterogeneity. Findings revealed escalating suicide rates, with significant burden among young adults and certain states like Kerala and Sikkim. Families experience profound psychological distress compounded by stigma, while the community ripple effect extends suicide’s impact widely. Regional and demographic disparities underscore the need for localized, culturally sensitive interventions. Addressing India’s suicide crisis required integrated, contextually relevant prevention and postvention framework supported by improved data quality and sustained research efforts to mitigate the pervasive psychosocial and public health consequences.
Mucinous neoplasms of ovary are diagnostically challenging, especially delineating these tumours as to primary or metastatic in nature, is crucial for effective management. Fifty year female presented with lower abdominal pain since one month. Imaging was suggestive of cystic lesions in both ovaries, likely neoplastic along with ascites. Provisional diagnosis of primary ovarian neoplasm was made. Ascitic fluid revealed jelly like material on gross examination; cytology and cell block was reported as pseudomyxoma peritoni. Gross and histopatholgy features revealed diagnosis of bilateral benign mucinous cystadenoma. However, at immunohistochemistry, mucinous epithelium was positive for CK20, SATB2 and negative for CK7, PAX8 and p16 suggesting metastasis from lower gastrointestinal tract. Further surgical exploration was done, confirming appendiceal low grade mucinous neoplasm at histopathology as primary tumour. This case emphasizes the diagnostic challenges posed by mucinous ovarian neoplasm and the critical role of comprehensive diagnostic evaluation to avoid misdiagnosis and ensure accurate treatment.
Background: Undernutrition is an important public health issue affecting a large number of children, especially in low and middle-income countries. Undernourished children have a higher risk of death, illness, poor physical and cognitive development, and increased risk of chronic disease in older age. The present study was conducted to assess the prevalence of different forms of undernutrition among Garo children. Method: The cross-sectional data were collected from 90 Garo children (40 girls and 50 boys) aged below 8 years through random sampling from Chidaogre village of West Garo Hills, Meghalaya. Data on the child’s health, undernutrition, health check-up, immunization, duration of breastfeeding, mothers’ age at marriage and socioeconomic conditions, etc. were collected. Anthropometric measurements were also taken from the children. Result: The frequency of both underweight (boys-30.0%, girls-15.0%) and thinness (boys-32.0%, girls-20.0%) was higher among boys than girls. Stunting was found to be higher among girls (22.5%) than boys (16.0%). The frequency of underweight (43.7%) and stunting (37.5%) was found higher among boys from low-income families. The higher frequency of underweight (girls-22.2%, boys-56.2%), stunting (girls-33.3%, boys-31.2%) and thinness (girls-33.3%, boys-43.7%) was found in both boys and girls whose mothers married before 18 years of age. Conclusion: The study highlights the high prevalence of undernutrition among children. Girls of illiterate or primary educated mothers have a higher frequency of undernutrition. Mothers who married before 18 years of age have higher undernourished children. Immunized girls show a lower prevalence of undernutrition, though it varies among boys.
Introduction: The distal end of the radius bone is pivotal in maintaining the stability of the wrist joint. This area is particularly prone to fractures more than the upper end especially among the elderly population and its morphometric measurements can vary significantly across different ethnic groups. Therefore a thorough knowledge of the bony architecture of the lower end of the radius and its variations is crucial for designing the distal radius plate prosthesis for wrist fracture surgery and for reconstruction of flexor pollicis longus tendon. Aim of the study: To analyse the morphology and morphometric features of distal end of radius for understanding their clinical implications in orthopedic practice. Methods: 110 dry human radius bones were collected and the following parameters were studied including styloid process length, circumferential diameter at the distal end and the inferior articular surface lateral and medial facet shape. Statistical analysis was performed using SPSS Software version 16. Result: The mean length of right styloid process was 1.15 ± 0.16 cm and left side was 1.10 ± 0.14cm. In contrast the lateral facets was primarily triangular on right side in 67% and on left side in 96% with a smaller percentage of oval shapes on right side 32% and left side 5.4% and no quadrangular shapes were observed. Conclusion: The current study shows that length of the styloid process and the morphology of the inferior articular facet on the right side exhibits distinct characteristics in the population.
Background: Global diets are increasingly dominated by a narrow range of plant and animal species, despite the availability of thousands of edible options. This dietary homogenization has coincided with rising rates of noncommunicable diseases (NCDs). Nutritional biodiversity, measured through Dietary Species Richness (DSR)—the number of unique edible species consumed—offers a novel approach to assessing and improving diet quality, with potential implications for human and planetary health. Objective: To systematically review and synthesize evidence linking DSR and related species-level diversity metrics to public health outcomes, including nutrient adequacy, gut microbiome composition, inflammation, and all-cause mortality. Methods: We searched multiple databases (PubMed, Scopus, Embase, Web of Science) and grey literature sources up to May 2025. Studies were eligible if they reported on species-level dietary diversity (e.g., DSR, Hill numbers) and at least one health-related outcome. Risk of bias was assessed using ROBINS-I and RoB 2.0; certainty of evidence was evaluated using GRADE. Results: Fifteen studies met inclusion criteria (11 observational; 4 RCTs), encompassing >450,000 participants across diverse settings. Micronutrient adequacy: Eight observational studies in LMICs and high-income countries found a consistent positive association between DSR and nutrient adequacy (+0.03 NAR per species; p < 0.001). Mortality: Meta-analysis of five European cohorts (n ≈ 450,000) showed a 37% reduced risk of all-cause mortality among those in the highest DSR quintile (pooled HR = 0.68; 95% CI: 0.60–0.77; I² = 46%). Microbiome and inflammation: RCTs using fermented food as a proxy for DSR showed increased α-diversity (~10–15%) and reductions in inflammatory proteins (e.g., IL-6), though no trials directly manipulated DSR as an intervention. Conclusions: Species-level dietary diversity, particularly as measured by DSR, is a consistent and underutilized predictor of improved nutritional adequacy, microbiome resilience, and reduced mortality risk. Despite promising associations, RCTs explicitly manipulating DSR remain absent. Integrating DSR into dietary guidelines, clinical screening tools, and sustainability policies offers a novel and actionable pathway toward aligning nutrition and biodiversity goals.
Black Plastics (BC) are widely used in food packaging, toys, consumer electronics, automobile parts and have raised growing concerns about their potential impacts on human health. These plastics which are often made from recovered electronic trash (e-waste), can include a complex mixture of toxic compounds such as brominated flame retardants, heavy metals, and persistent organic pollutants. This paper critically evaluates the existing scientific understanding of black plastics as potential endocrine-disruptive materials for vulnerable populations. Relevant literature was sourced from online sources and published articles between January and June 2025. This study investigated the BC chemical compounds capable of mimicking or interfering with hormonal activity and its mechanism, as well as the impacts on public health, the environmental and transgenerational repercussions. The analysis emphasizes the urgent need for more comprehensive toxicological research to reduce human exposure to endocrine-disrupting compounds found in black plastics.
The parotid gland mucoepidermoid carcinoma (MEC) is the most common primary malignant tumor of the salivary glands. Metastatic tumors of parotid account for approximately 25% of all cases. The commonest malignancies to spread to intraparotid lymph nodes are squamous cell carcinoma, followed by melanoma and, less frequently, cancers from the oral cavity. Usually, cutaneous melanoma in the head and neck area is the precursor of malignant melanoma in the parotid gland. However, the exact process underlying the existence of melanin pigment in salivary gland tissue is unknown. A 72-year-old woman with a history of conjunctival melanoma arrived at the otolaryngology outpatient clinic complaining of preauricular pain and swelling. It was a 1.5 × 1.5 cm lesion. Given the background, cytology revealed high-grade malignancy with pigmentation upon fine needle aspiration, which was suggestive of malignant melanoma. On Cellblock and immunohistochemistry, it was confirmed as pigmented MEC. This case underscores the importance of immunohistochemistry and CB preparation in both diagnosis and patient care. In pathology, the existence of melanin pigment is a fascinating phenomenon, and melanin pigment that causes lesions is not invariably a sign of malignant melanoma.
Background: The shortage of healthcare professionals and unequal distribution of health workers in many developing nations are widely recognized. Still, there has been limited effort to assess the level of inequality amongst healthcare professionals in the Kingdom of Saudi Arabia (KSA). This research investigates the distribution of physicians, dentists, nurses and midwives, and pharmacists among the 20 healthcare regions in the KSA. Materials and Methods: An analysis of secondary data was carried out using the Statistical Yearbook of the Saudi Ministry of Health for the year 2022. The research focused on determining the ratio of physicians, dentists, nurses, and pharmacists per 1,0000 people employed in the healthcare facilities of the Ministry of Health and the private sector in the 20 health regions of the KSA. The examination included evaluating the distribution of the healthcare professionals in different regions using the Lorenz curve, and the Gini coefficient. Results: There are fair distribution of physicians, dentists, nurses, and pharmacists across different regions. The mean Gini coefficient calculated for physician distribution was 0.11, dentists 0.08, nurses and midwives 0.16, and pharmacists 0.12 respectively, suggesting fair healthcare professionals distribution across regions. The research also highlighted the additional requirements for 4493 dentists, 69551 nurses and midwives, and 2811 pharmacists to adhere to the global benchmark of 8.2 dentists, 70.6 nurses and midwives, and 9.4 pharmacists per 10000 population. Conclusion: The research emphasizes the significance of focused healthcare planning and policy interventions to distribute healthcare professionals equally across the Kingdom's health regions.
Aim: Anaplastic thyroid carcinoma (ATC) is highly aggressive, comprises <4% with dismal prognosis. This study examines the clinical, pathological, prognostic features and outcomes. Methods: We retrospectively analysed 15 cases of ATC over 6-years. Clinicopathological data, immunohistochemistry, morphological subtypes, treatment and survival were assessed using Kaplan-Meier curves. Results: The mean age was 66.1 years, with female predominance(M:F=1:2). Commonest symptom included neck swelling. 33.3% had long-standing goitre with rapid enlargement and 80% presented with tumours >5cm exhibiting local invasion(80%), distant metastasis(60%), particularly to the lungs(53.3%) and bones(26.6%). Histological subtypes included epithelioid(33.3%), sarcomatoid(33.3%), squamous(26.6%) and pleomorphic/rhabdoid(6.6%) with coexisting differentiated thyroid carcinoma(DTC) noted in 46.6%. Epithelioid and squamous ATC showed higher association with DTC and exhibited high tumour infiltrating lymphocytes. Immunohistochemistry revealed PAX8(66.6%), p53(73.3%) and BRAF(53.3%) positivity; latter showing expression in epithelioid(26.6%) and squamous(13.3%) ATC. Two patients with BRAF associated squamous ATC arising from papillary thyroid carcinoma precursor showed prolonged survival. The median overall survival was one month. Conclusions: ATC is an aggressive thyroid malignancy with poor outcomes. Histological subtype and BRAFV600E status may aid in prognostication and targeted therapy selection.
Globally, one in three adults suffer from multimorbidity. The challenges of multimorbidity in low-middle income countries are accentuated by social inequity, environmental degradation and inefficiencies in health systems. This study examines the prevalence and determinants of multi-morbidity across population sub-groups using the database of 71st round of National Sample Survey. ‘Multi-morbidity’ is operationalised in terms of ‘number of hospitalizations.’ Individuals reporting multiple hospitalizations due to multiple ailments are considered as a case of multi-morbidity. We find that 8.43% adults reported multimorbidity. Pearson’s chi squared test is performed to see whether any relationship exists between its episode and socio demographic characteristics. Elderly and women are the commonly affected groups. Binary logistic regression analyses shows a significant association between multi-morbidity and variables like - age, gender, geographic zones and the insurance coverage. The study manifests novel approach of defining ‘multi-morbidity’ and highlights the need to design age and gender specific combating strategies.
Background: The thyroglossal duct cyst (TGDC) is the commonest embryological thyroid developmental abnormality. It is usual to find dispersed ectopic thyroid tissue within TGDCs, but malignant transformation is expected to occur in less than 1% of cases. We present this unusual case which was misdiagnosed on fine needle aspiration cytology (FNAC) as colloid goitre. Case Report: A 60 year old female presented with swelling in front of neck. At ultrasound examination a diagnosis of benign lesion was rendered as TIRADS 0 in left lobe, TIRADS I in right lobe and TIRADS III in the isthmus. Thyroid hormone assay was within normal limits. At FNAC a diagnosis of Colloid Goitre (TBSRTC) was made. Computed tomography of neck was also suggestive of a benign solid cystic lesion. Left hemi thyroidectomy was done and specimen sent for histopathology which was reported as papillary carcinoma-classic type arising in a thyroglossal duct cyst. Conclusion: The present case highlights the importance of considering malignancy, however infrequent, in the differential diagnosis of TGDC masses, even in the absence of overt suspicious features. The case underscores the need for thorough pathological examination of excised TGDCs to identify such unexpected findings.
Perivascular tumors are rare mesenchymal neoplasms of unclear line of differentiation, presumed to be derived from pericytes or a modified perivascular cell, with very few articles published in the literature. It is classified as benign, intermediate, and malignant. We hereby report five cases of perivascular tumor. Three cases were reported as myopericytoma (MPC), one case was reported as a myofibroma(MF), while one case was of glomangioma. Myopericytomas are typically benign, slow-growing, but rare malignant variants exist- hence, complete excision and follow-up are advised. Myofibromas, on the other hand, are commonly solitary and benign, but infantile myofibromatosis can be aggressive or fatal if visceral involvement occurs. Glomangiomas are benign, though multiple lesions (glomangiomatosis) can be painful and cosmetically concerning. Hence, differentiating perivascular tumors is critically important in clinical practice and pathology because while they share overlapping histological features as perivascular tumors, they differ in biological behaviour, treatment approach, syndromic associations, and immunohistochemical profile.
Background: Dietary diversity is a key factor of child nutrition, yet its effect across different forms of undernutrition is not fully understood. Therefore, this study aims estimate the link between dietary diversity and undernutrition among children in Uttar Pradesh, and evaluate the moderating effect of socio-economic status on this relationship. Materials and Methods: Data from the NFHS-5 (2019–21) were analyzed for 29,196 children aged 6–59 months. Nutritional status was classified using WHO child growth standards. Graphical representation and chi-square tests are used to assess the association between malnutrition with background characteristics. Multinomial logistic regression is used to identify predictors of nutritional outcomes. R studio software was used to analyze the data. Results: Stunting (43.6%) was most prevalent in children aged 36–59 months, while wasting and underweight were found in the 6–23-month age group (p < 0.001). Boys had a higher prevalence of malnutrition than girls. Child from poorer households had significantly higher risks of stunting (RRR = 1.59), underweight (RRR = 1.57), and multiple undernutrition (RRR = 1.90). Maternal education showed a protective effect across all forms of undernutrition. The effect of low dietary diversity was not significant in adjusted models, but an interaction term revealed that its negative impact was pronounced among children from poor households especially for multiple undernutrition (RRR = 2.89; p < 0.001). Conclusion: Undernutrition is primarily affected by poverty/low maternal education, rather than dietary diversity alone. Low dietary diversity impact on nutritional status is prominent in poorer households. Targeted, multi-sectoral interventions that promote maternal education, dietary improvements, and healthcare access are essential to reduce nutritional disparities among children in Uttar Pradesh.
Background: Brown tumors (BT) with an overall incidence of 2-3%, are rare but characteristic presenting features of primary hyperparathyroidism (PHPTH) which are often missed, resulting in delayed diagnosis. We present two unique cases where bony lesions were the initial presentation of BT, ultimately unravelling PHPTH. Method: First case involves a 43 year male presenting with repeated femur fractures, generalized fatigue and bony pain with Bone scan suggesting Metabolic bone disease. Second case was of a 36 year male presenting with painful deformity at left humerus fracture site. Result: Both cases on histopathology were reported as Brown tumor, with subsequent work up revealing metabolic derangements and Parathyroid adenoma in each. Conclusion: This report highlights that fractures can mask rare osteolytic lesions like BT, which may serve as the first clue to PHPTH. Histopathological evaluation of debrided tissue becomes crucial to catch the lesion early as it is gold standard for diagnosis complemented with a multidisciplinary approach.
Objective: To evaluate the oral cavity of tobacco and non-tobacco consumers, focusing on the severity of oral submucous fibrosis (OSF) using clinical diagnostic scales and molecular biomarkers. Design: A comparative cross-sectional study. Methods: A total of 200 individuals scheduled for general surgeries (100 tobacco consumers and 100 non-tobacco consumers) were assessed. OSF severity was evaluated using Mallampati Classification (MPC), Maximal Mouth Opening (MMO), dysphagia scoring, and Thyromental Distance (TD). Additionally, the Kallikrein, Adam, and Cathepsin genes were examined as molecular biomarkers due to their relevance in various health conditions. Results: A significantly higher number of males were observed in the tobacco group (p-value = 0.0018). The mean age was 48.02 ± 16.5 years for tobacco users and 46.52 ± 13.3 years for non-users, with no significant age difference (p-value = 0.4805). Significant differences were found between the two groups in MPC, MMO, and dysphagia (all p-values = 0.000), indicating higher OSF severity in tobacco consumers. No significant difference was observed in TD (p-value = 0.761). Molecular analysis revealed that 10% of participants tested positive for Kallikrein gene amplification, while Adam and Cathepsin gene amplification was not detected. Conclusion: Tobacco consumption is associated with significant changes in oral diagnostic parameters, suggesting an elevated risk of OSF. The clinical diagnostic scales used are effective in identifying OSF severity, and Kallikrein gene amplification may serve as a potential molecular marker. These findings support the integration of clinical and molecular diagnostics for early detection in tobacco chewers.
Introduction: Xanthogranulomatous inflammation (XGI) is an uncommon variant of chronic inflammation and a well-established pathological entity involving various organs and systems. The commonest site of XGI is the gall bladder and kidney. It is rare in the head and neck region. Only 13 cases have been reported in the head and neck region to date at different locations. The exact pathophysiology of XGI remains unexplained. It may be associated with trauma, post-surgery, infection, obstruction, defective lipid transport, and immunological disturbances, and is often confused with a malignant neoplasm. The conclusive diagnosis is made through histopathology. Case Report: We present a unique case of a huge neck mass measuring 25x25 cm in a 76-year-old patient who was diagnosed clinically and radiologically as a thyroglossal cyst and/or colloid goitre, respectively. On histopathological examination, the mass showed extensive XGI replacing the bilateral lobes of the thyroid parenchyma. The differentials included malakoplakia, tuberculosis, or metastatic cystic squamous cell carcinoma. Conclusion: To the best of my knowledge, this is the first reported case where the primary xanthogranuloma of the thyroid presented as a huge cystic neck mass in the absence of any congenital cysts, and the patient was both surgically naïve and non-diabetic. The histopathological examination is mandatory to rule out the possibility of other lesions. However, the pathophysiology is unexplained. Awareness of this inflammatory lesion is important to the pathologist and treating surgeon to prevent extensive surgery.
Achalasia is an uncommon esophageal motility disorder characterized by the failure of the lower esophageal sphincter to relax in response to swallowing and weak to absent esophageal peristalsis. In advanced stages, the esophagus gets grossly dilated, attaining a sigmoid configuration. We present one such case of sigmoid esophagus due to its rare occurrence. The managed was managed successfully with laparoscopic Heller myotomy.
