Introduction: Chronic otitis media (COM) is a common cause of preventable hearing impairment requiring surgical intervention. The Middle Ear Risk Index (MERI) is used to assess disease severity and predict surgical outcomes. However, its prognostic reliability remains uncertain. This study aimed to evaluate the correlation between preoperative MERI scores and postoperative hearing improvement, anatomical outcomes and complications following tympano-mastoid surgery. Materials and Methods: This prospective observational study included 161 patients with COM undergoing tympano-mastoid surgery at a tertiary care teaching hospital in Kerala. Preoperative disease severity was assessed using MERI and classified as mild, moderate or severe. Hearing improvement was evaluated using postoperative air–bone gap (ABG) improvement. Anatomical outcomes and complications were assessed at one and three months. Statistical analysis included Pearson correlation, analysis of variance, chi-square tests and multivariable linear regression. Results: The mean age was 35.59 ± 14.74 years, and the mean MERI score was 3.53 ± 2.33. Mild, moderate and severe MERI categories comprised 60.9%, 24.8% and 14.3% of patients, respectively. Overall mean ABG improvement was 17.30 ± 10.55 dB. No significant correlation was observed between MERI score and ABG improvement (r = −0.023, p = 0.777). Hearing improvement was comparable across MERI categories (p = 0.910). Multivariable regression identified no independent predictors of hearing improvement. Three-month perforation occurred in 13.7% of patients and was not significantly associated with MERI severity (p = 0.366). Postoperative complications increased with MERI severity (p = 0.021), although this association requires cautious interpretation. Conclusion: Preoperative MERI scores did not significantly predict postoperative hearing improvement or three-month perforation. MERI may assist in disease severity assessment and risk stratification but should not be used independently to predict surgical success.
Background and Objectives: Renal biopsy interpretation requires correlation of clinical findings with structural alterations and immune-deposit patterns. This study was done with an objective to describe the histomorphological spectrum of glomerular diseases and separately assessed the additional diagnostic information provided by special stains and immunofluorescence (IF). Materials and Methods: This single-centre prospective descriptive study included 52 adequate renal biopsies received at Government Mohan Kumaramangalam Medical College and Hospital, Salem, between November 2019 and June 2021. Haematoxylin and eosin, periodic acid–Schiff and Jones methenamine silver stains were examined; IF findings were reviewed when tissue was available. Results were summarised descriptively. Results: Mean age was 31.06 ± 11.43 years; 29 patients (55.8%) were female. Primary glomerular diseases comprised 39 biopsies (75.0%), and secondary diseases 13 (25.0%). Minimal change disease was the commonest primary diagnosis (9/52, 17.3%), followed by IgA nephropathy and endocapillary proliferative glomerulonephritis (8/52 each, 15.4%). Lupus nephritis was the commonest secondary diagnosis (10/52, 19.2%). IF was performed in 44 cases (84.6%); in four cases (4/44, 9.1%) it contributed to a reported diagnostic refinement, including three IgA nephropathy cases and one class III lupus nephritis case. Conclusion: The biopsies demonstrated varied glomerular pathology. Special stains improved structural assessment, whereas IF added diagnostically relevant information in selected cases.
Background and Objectives: Fungal rhinosinusitis may present as allergic disease, a non-invasive fungal ball, or infection involving the surrounding tissues. This study examined the fungal species recovered from patients with rhinosinusitis, the types of fungal disease encountered, associated clinical conditions, and antifungal susceptibility findings. Methods: This prospective hospital-based study included 106 patients with chronic rhinosinusitis who underwent diagnostic nasal endoscopy and/or functional endoscopic sinus surgery at Coimbatore Medical College Hospital. Samples were examined by potassium hydroxide microscopy, fungal culture, and histopathology. Amphotericin B minimum inhibitory concentrations (MICs) were measured by broth microdilution and Etest. Voriconazole MICs were also assessed for Aspergillus isolates. Results: Fungal rhinosinusitis was identified in 22 of 106 patients (20.8%). Of these 22 cases, 15 (68.2%) had allergic fungal rhinosinusitis, three (13.6%) had chronic invasive disease, two (9.1%) had acute invasive disease, and one each (4.5%) had a fungal ball or chronic granulomatous disease. Aspergillus flavus was the commonest isolate (11/22; 50%). KOH microscopy was positive in 21 cases and histopathology in 17. Asthma or diabetes was recorded in 15 of 22 fungal cases and 19 of 84 non-fungal cases. Conclusion: Fungal rhinosinusitis was found in about one in five patients in this selected endoscopic and surgical cohort, most often in its allergic form. Microscopy, culture, and histopathology should be interpreted together. Antifungal MIC results need careful interpretation because validated species-specific clinical breakpoints are not always available.
Every clinician now practises inside a stream of announced breakthroughs, and the ability to judge the study behind the headline has become a core clinical skill. The perspective article in this issue makes that case plainly and usefully. It reminds us that the distance between a promising result and a proven therapy is long: in the meta-analysis it cites, half of therapies moved from animal to human trials and 40% reached randomised controlled trials, yet only 5% won regulatory approval.
Background and Objective: Triple-negative breast cancer (TNBC) is an aggressive and heterogeneous subtype of breast cancer. Cytokeratin 5/6 (CK5/6) and epidermal growth factor receptor (EGFR) are basal markers that may be associated with tumour characteristics. This study aimed to evaluate CK5/6 and EGFR expression in TNBC and determine their association with clinicopathological parameters. Materials and Methods: This hospital-based, observational cross-sectional study included 34 consecutive patients diagnosed with TNBC at Government Kilpauk Medical College and Hospital over six months. Tumour specimens were examined histopathologically, and immunohistochemistry was performed to assess CK5/6 and EGFR expression. Associations with age, tumour size, histological grade, pathological stage, tumour-infiltrating lymphocytes, lymph node metastasis and Ki-67 index were analysed using Fisher's exact test. A p-value <0.05 was considered statistically significant. Results: The mean age of patients was 52.9 years. Most tumours measured 2–5 cm (52.9%), were histological grade 2 (61.8%) and belonged to stage II (52.9%). CK5/6 positivity was observed in 14 cases (41.2%), while EGFR positivity was detected in 18 cases (52.9%). Both markers were positive in 12 cases (35.3%), and 20 cases (58.8%) expressed at least one marker. EGFR expression showed a statistically significant association with tumour size (p=0.049). Neither marker showed a significant association with the other clinicopathological parameters studied. Conclusion: CK5/6 and EGFR showed variable expression in TNBC. EGFR expression was associated with tumour size, although this finding requires cautious interpretation because of the small sample size and multiple comparisons. Larger studies with clinical follow-up are needed to establish the prognostic relevance of these markers.
