Sellar–suprasellar lesions are most commonly pituitary adenomas; however, rare vascular tumors such as hemangioblastomas (HBs) may closely mimic them, posing significant diagnostic challenges. HBs are typically associated with von Hippel–Lindau (VHL) disease and are seldom encountered in the sellar region, with only a few cases documented. We report a 37-year-old male presenting with chronic headache and progressive visual impairment characterized by bitemporal hemianopia. Neuroimaging revealed a heterogeneously enhancing sellar–suprasellar mass with bony erosion, initially suggestive of pituitary macroadenoma. Hormonal evaluation was unremarkable, and endoscopic biopsy proved inconclusive. The patient underwent right pterional craniotomy, during which a highly vascular tumor limited complete excision. Histopathological analysis confirmed HB (World Health Organization Grade I). Post-operative evaluation excluded associated VHL disease. This case underscores the importance of including HB in the differential diagnosis of hypervascular sellar lesions. Pre-operative recognition is crucial to anticipate intraoperative hemorrhagic risk and optimize surgical planning.
Background: Convulsive status epilepticus (CSE) is a pediatric neurological emergency requiring urgent intervention. It may result from febrile illness, central nervous system infection, metabolic disturbances, or neurological disorders and may cause morbidity, mortality, and sequelae when treatment is delayed. Aims and Objectives: The aim of the study was to describe the clinical profile and etiological spectrum of CSE in children aged 1 month–12 years and identify factors associated with short-term outcome at discharge. Materials and Methods: This prospective observational study included 100 consecutive children aged 1 month–12 years admitted with CSE to the pediatric intensive care unit or child medical ward of a tertiary care hospital. Clinical details, examination findings, investigations, neuroimaging, cerebrospinal fluid examination, and electroencephalography were recorded when indicated. Outcomes at discharge were classified as complete recovery, neurological deficit, or death. Results: Children aged 1–5 years formed the largest subgroup, with a slight male predominance. Fever was the most common clinical feature, and generalized tonic-clonic seizures were the predominant seizure type. Acute symptomatic etiology was most frequent, followed by febrile status and remote symptomatic causes. At discharge, 78% recovered completely, 16% had a neurological deficit, and 6% died. Unfavorable outcome was significantly associated with delayed treatment, seizure type, recurrent seizures after admission, acute symptomatic etiology, lower Glasgow Coma Scale score, and requirement of more antiepileptic drugs. Conclusion: Most children recovered fully; however, morbidity and mortality remained important. Early treatment and close monitoring of children with acute symptomatic etiology, depressed sensorium, recurrent seizures, or drug-refractory status are essential to improve short-term outcome.
Background: Advanced head and neck cancers frequently present at incurable stages, where palliative radiotherapy is essential for symptom control. Conventional hypofractionated schedules often cause significant toxicity. Aims and Objectives: The aim of the study was to compare clinical outcomes of the QUAD SHOT regimen versus 30 Gy in 10 fractions in Stage III–IV head and neck cancer. Materials and Methods: In this prospective comparative study, 160 patients received either QUAD SHOT (14 Gy/4 fractions) or 30 Gy/10 fractions. Tumor response (RECIST), toxicity (Radiation Therapy Oncology Group), and quality of life (EORTC QLQ-H&N35) were assessed. Results: Most patients were male and >60 years. Grade 3 mucositis occurred in 37.5% with 30 Gy/10 fractions but was absent with QUAD SHOT (P<0.001). Grade 2 skin toxicity was absent in QUAD SHOT and seen in 3.75% with 30 Gy/10 fractions (P<0.001). Partial response rates were comparable (71.3% vs. 72.5%). Pain relief was superior with QUAD SHOT (35% vs. 11.3%, P<0.001). Conclusion: QUAD SHOT achieved similar tumor response with lower toxicity and improved pain relief, supporting its role as a well-tolerated palliative option in advanced head and neck cancer.
Background: Empyema thoracis is a serious pleural infection in children, most often arising as a complication of bacterial pneumonia. It contributes significantly to morbidity and, if inadequately treated, may result in irreversible pulmonary damage. Video-assisted thoracoscopic surgery (VATS) has become a preferred minimally invasive approach for advanced empyema. Aims and Objectives: The aim of the study is to assess the safety and effectiveness of the two-port VATS technique in pediatric empyema thoracis, focusing on operative outcomes, complications, and recovery. Materials and Methods: A retrospective observational study was conducted over 2 years, including 50 pediatric patients aged 1 month to 15 years with stage II/III empyema that was unresponsive to medical therapy. All underwent two-port VATS for decortication and lung re-expansion. Data on operative time, hospital stay, complications, and conversion to thoracotomy were analyzed. Results: Two-port VATS achieved satisfactory lung re-expansion and effective decortication in the majority of cases. The mean operative time was 75 min, and the average post-operative hospital stay was 12 days. Complications were minimal: One minor air leak and two cases requiring prolonged drainage. Four patients with chronic empyema required conversion to open thoracotomy. Overall morbidity was low, and cosmetic outcomes were favorable. Conclusion: Two-port VATS is a safe and effective modality for managing pediatric empyema thoracis. Compared to traditional thoracotomy, it offers reduced morbidity, shorter recovery, and superior cosmetic results. It should be considered a preferred surgical option in children with advanced empyema not responding to medical therapy.
Background: Antimicrobial resistance (AMR) is a major global public health concern. Self-medication and the misconception about antibiotics are the major drivers of resistance. The key factors in the use of antibiotics are the knowledge, attitude, and practices (KAP) of the people. Poor knowledge and attitudes favor the emergence of resistant strains. Aims and Objectives: The aim of the study was to assess the level of KAP regarding antibiotic use and resistance in an urban community of Kancheepuram and identify the associated sociodemographic factors. Materials and Methods: A community-based cross-sectional study was conducted among 450 participants using an interview schedule consisting of KAP questions on antibiotic use during September–October 2025. The quantitative variables were expressed as mean±standard deviation, and qualitative data were presented as frequency and proportion. Associations were analyzed using Chi-square test, and differences between KAP domains were assessed using Friedman’s test. Results: The mean age of the study participants was 43.6±13.8 years. Majority of the study participants had moderate knowledge (52.9%) and moderate attitude (52.4%) while 61.5% had good practice. Levels of education of study participants had a significant association with their knowledge, attitude, and practice regarding antibiotic use. Conclusion: Overall, the findings of the present study support that irrational use of antibiotics is still very common, although there is moderate awareness on antibiotic resistance. To reduce inappropriate antibiotic use and fight AMR, community-based educational initiatives, legislative control on antibiotic dispensation and pharmacist-led stewardship activities are needed.
Background: Cigarette smoking remains the leading preventable cause of morbidity and mortality worldwide. Cotinine, a metabolite of nicotine, serves as a reliable biomarker of tobacco exposure due to its longer half-life (18–20 h) compared to nicotine (2–3 h). Aims and Objective: The present study aimed to measure serum cotinine levels in cigarette smokers and examines their relationship with smoking duration and intensity, thereby validating smoking status. Materials and Methods: This case–control study was conducted at a tertiary care center in the Kumaon region of Northern India, including 284 healthy cigarette smokers (cases) aged 18–60 years and 284 age- and sex-matched non-smokers (controls). Detailed smoking histories were obtained, and participants were categorized into four groups based on cigarettes/day and duration: Very mild (Group I: 1–10/day, <5 years), mild (Group II: 11–20/day, <5 years), moderate (Group III: 11–20/day, 5–10 years), and heavy smokers (Group IV: 11–20/day, >10 years). Serum cotinine was quantified using high-pressure liquid chromatography. Results: Smokers were predominantly male, with a mean age of 41.68±11.52 years. Serum cotinine levels were significantly higher in smokers compared to non-smokers (P<0.05), with values increasing proportionally to smoking duration and intensity. Conclusion: This study demonstrates a strong positive correlation between serum cotinine levels and smoking behavior, supporting its utility as a biomarker for identifying and validating smoking status. Routine measurement of cotinine in serum or urine may aid in detecting both active and passive smokers, thereby enhancing tobacco control strategies.
Background: Low and middle-income countries have seen an increase in the prevalence of type 2 diabetes mellitus (DM) in recent years. Glycated hemoglobin (HbA1c) provides a measurement of body glycemic control for 2–3 months. Magnesium and Vitamin D have been shown to have a role in insulin and blood glucose levels. Aims and Objectives: This study aims to explore the association of serum magnesium and Vitamin D with HbA1c among patients with type 2 DM, in a tertiary care hospital of the Eastern region of Nepal. Materials and Methods: This cross-sectional study was conducted among 70 patients with type 2 DM. Ethical clearance was obtained from the Institutional Review Committee of Nobel Medical College Teaching Hospital. HbA1c, magnesium levels and Vitamin D levels were categorized as per hospital laboratory protocol. Results: More than half of the patients were males (51.4%). More than half had either inadequate or poor glycemic control (57.1%). The serum Vitamin D levels (58.6%) and magnesium levels (90%) recorded were mostly adequate. A negative association was observed between Vitamin D and HbA1c (r=−0.31; P=0.01). A negative association was observed between magnesium and HbA1c (r =−0.43; P=0.001). Conclusion: A significant negative association was observed between both serum magnesium and Vitamin D and HbA1c.
Background: Psoriasis is a chronic inflammatory disease that impairs physical health and quality of life. Conventional therapies often yield variable responses, highlighting the need for adjunctive options. Aims and Objectives: The aim of the study was to evaluate the efficacy and safety of pioglitazone as an addon to standard treatment in moderate to severe psoriasis. Materials and Methods: An openlabel, randomized, interventional study was conducted in the dermatology outpatient department of a tertiary care hospital. Ninety patients were equally allocated into three groups: Standard therapy alone, standard therapy plus pioglitazone 7.5 mg/day, or plus 15 mg/day. Patients were followed for 12 weeks. Results: Baseline characteristics and psoriasis area and severity index (PASI) scores were comparable across groups. No significant differences were observed at baseline (P=0.643) or week 4 (P=0.762). Significant PASI reduction emerged at week 8 (P=0.008) and week 12 (P<0.001), with the higherdose group showing superior improvement (P<0.001). PASI ≥50 was achieved in 57.7%, 64.0%, and 81.5% of patients, while PASI ≥75 was attained only in the higherdose group (18.5%). Mean PASI improvement was 50.0%, 47.2%, and 66.8% in Groups A, B, and C, respectively. Dermatology life quality index scores improved in all groups, with the greatest reduction in the higherdose group (10.56±5.02), followed by 8.00±3.32 and 6.81±2.48 (P=0.015 at week 12). Adverse events were mild, mainly gastrointestinal, with no serious events. Conclusion: Pioglitazone addon therapy improved disease severity and quality of life, with greater benefit at higher doses and good tolerability, supporting its potential as an adjunct option.
Background: Male infertility accounts for nearly half of all infertility cases worldwide, and semen analysis alone cannot identify structural abnormalities in the male reproductive tract. Aims and Objectives: This study aimed to evaluate the role of scrotal and transrectal ultrasonography (TRUS) in detecting pathological abnormalities in infertile males with abnormal semen parameters. Materials and Methods: This cross-sectional study included 65 patients with abnormal semen analysis at Government Stanley Medical College and Hospital, Chennai, between April 2021 and March 2022. All patients underwent scrotal ultrasonography using a high-frequency transducer and TRUS to evaluate the testes, epididymis, spermatic cord, prostate, seminal vesicles, and vas deferens. Results: The mean age of the patients was 31.3±4.6 years, with most patients belonging to the 21–30-year age group (33 [50.8%]). Varicocele was the most common ultrasonographic abnormality, identified in 26 (40.0%) patients, including left-sided varicocele in 14 (21.5%) and bilateral varicocele in 12 (18.4%) patients. Hydrocele was observed in 6 (9.2%) patients, epididymal cyst in 5 (7.7%), dilated vas deferens in 4 (6.2%), and dilated seminal vesicle in 3 (4.6%) patients. Reduced sperm volume was the most common semen abnormality (19 [29.2%] patients). Varicocele was significantly associated with reduced testicular volume (P<0.05). Conclusion: Scrotal and TRUS are valuable imaging modalities for identifying potentially correctable abnormalities in men with infertility.
Background: Laparoscopic cholecystectomy is the standard treatment for gallstone disease, but may not be feasible in patients with significant comorbidities, hostile abdomens, or contraindications to pneumoperitoneum. Aims and Objectives: This study evaluated outcomes of open cholecystectomy using a small upper midline incision in high-risk patients. Materials and Methods: A retrospective case series of 53 high-risk patients undergoing open cholecystectomy through a small upper midline incision between October 2018 and October 2025 was conducted. Demographic, perioperative, and post-operative outcomes were analyzed descriptively. Results: Of 53 patients, 69.8% were female, and all had at least one comorbidity. Mean operative time was 28.0±11.0 min. Mean post-operative day 1 (POD 1) pain score, Visual Analog Scale was 5.0±1.3. Post-operative nausea and vomiting occurred in 5.7%, and no surgical site infections were observed. Most of the patients (77.4%) were discharged on POD 1, with a mean hospital stay of 2.2±0.5 days. Conclusion: A small upper midline incision with self-retaining retraction appears to be a feasible open approach for selected high-risk patients requiring cholecystectomy, demonstrating acceptable post-operative pain, low early morbidity, and short hospital stay. Prospective comparative studies are needed.
Background: Vitamin D is essential for calcium homeostasis and exerts widespread effects on cardiovascular physiology through the Vitamin D receptor (VDR). Emerging evidence suggests that Vitamin D deficiency may contribute to hypertension through the modulation of the renin–angiotensin–aldosterone system and endothelial function. Aims and Objectives: This study aimed to evaluate the correlation between serum Vitamin D levels and hypertension in adults attending a tertiary care hospital. Materials and Methods: A hospital-based case–control study was conducted in the Department of Biochemistry, Himalaya Medical College and Hospital, Paliganj, Bihar, over 4 months following ethical approval. A total of 100 participants aged 30–65 years were enrolled, comprising 50 hypertensive patients (cases) and 50 normotensive individuals (controls). Serum Vitamin D3 levels were measured using chemiluminescent microparticle immunoassay on the Mini Vidas System. Data were analyzed with the Statistical Package for the Social Sciences version 30, and Pearson’s correlation coefficient was applied to assess associations, with P<0.05 considered significant. Results: The mean age of cases and controls was 50.8±8.3 years and 49.2±6.9 years, respectively. Hypertensive patients had significantly lower mean serum Vitamin D levels compared to controls (15.1±0.56 ng/mL vs. 24.1±1.1 ng/mL; P<0.001). Pearson’s correlation analysis revealed a significant negative correlation between Vitamin D levels and hypertension (r=−0.323, P=0.001). Conclusion: Hypertensive individuals exhibited significantly lower serum Vitamin D levels, with an inverse correlation between Vitamin D concentration and blood pressure. These findings suggest Vitamin D deficiency as a potential modifiable risk factor for hypertension, warranting larger prospective studies to establish causality and explore preventive strategies.
Background: Leprosy (Hansen’s disease), caused by Mycobacterium leprae, remains a source of morbidity, disability, and stigma despite India achieving elimination as a public health problem in 2005–2006. Early diagnosis is critical for timely treatment and prevention of transmission. Histopathology is a standard diagnostic tool, but may be limited in early or borderline lesions. Polymerase chain reaction (PCR) offers a sensitive molecular method for detecting M. leprae. Aims and Objectives: This study aimed to evaluate PCR’s diagnostic accuracy compared with histopathology and to assess the clinicopathological profile of leprosy cases in a tertiary care centre. Materials and Methods: A prospective comparative study was conducted from January 2021 to December 2022, enrolling 103 clinically diagnosed leprosy patients. Skin punch biopsies were subjected to histopathological examination and PCR analysis. Clinicopathological correlation and agreement between histopathology and PCR were assessed. Results: Most patients were aged 26–35 years, with male predominance. Extremities were the commonest sites of involvement. Clinically, borderline tuberculoid was most frequent, while borderline lepromatous predominated histologically. Overall clinicohistopathological concordance was 89%, highest in lepromatous leprosy. Histopathology and PCR findings were concordant in 89.4% of cases. Combined use of both modalities improved diagnostic accuracy to 95%. Conclusion: PCR is a valuable adjunct to histopathology, particularly in indeterminate and borderline cases where conventional methods may be inconclusive. Integrating PCR with routine evaluation enhances diagnostic accuracy, enabling earlier diagnosis and treatment, thereby reducing disability and stigma associated with Hansen’s disease.
Background: Percutaneous drainage has transformed hepatic abscess management, yet recovery trajectories remain heterogeneous. While procedural success is high, the pace of clinical resolution is dictated more by the host environment than by technical factors. Aims and Objectives: The aim of the study was to identify baseline predictors – C-reactive protein (CRP), glycemic status, and hemoglobin (Hb) levels – that influence time to clinical relief and hospital stay in patients undergoing percutaneous intervention for liver abscess. Materials and Methods: A prospective observational study of 36 patients with radiologically confirmed hepatic abscesses was conducted at a tertiary care center in Eastern India. Host-specific variables, including diabetes mellitus, anemia (Hb <10 g/dL), and high inflammatory burden (CRP >30 mg/L), were correlated with outcomes: time to apyrexia and duration of hospitalization. Results: The cohort demonstrated marked systemic inflammation (86% with total leukocyte count >11,000 cells/mm3). Diabetic patients had significantly delayed recovery, with a mean time to apyrexia of 5.8±1.2 days versus 3.2±0.8 days in non-diabetics (P=0.041). Anemia was strongly associated with prolonged hospital stay, with 81% requiring >10 days for stabilization (P=0.029). Elevated baseline CRP (>30 mg/L) was a robust predictor of extended hospitalization (P=0.0003), independent of drainage modality. Conclusion: Host metabolic and inflammatory milieu is a superior determinant of clinical resolution compared to procedural choice. Hyperglycemia and anemia impair parenchymal healing and prolong systemic inflammation. Risk stratification using baseline CRP, Hb, and glycemic status is essential for personalized management and resource optimization in liver abscess care.
Background: Peritonitis due to hollow viscus perforation is a surgical emergency associated with high mortality. Early risk stratification is essential. The Mannheim peritonitis index (MPI) is a validated prognostic tool. Aims and Objectives: This study aimed to evaluate the effectiveness of the MPI in predicting mortality, assess its role in morbidity prediction, and determine its prognostic value in risk stratification of perforation peritonitis. Materials and Methods: A cross-sectional study was conducted on 60 patients with perforated peritonitis over 24 months. Clinical, laboratory, and intraoperative variables were recorded. MPI scores were calculated. Associations with mortality and morbidity were analyzed using Chi-square tests. Receiver operating characteristic analysis was performed to assess diagnostic performance. Results: The most affected age group was 41–50 years (28.3%). Males constituted 81.7%. Organ failure occurred in 33.3%, and malignancy in 10%. Appendicular perforation was the most common source (35%), followed by gastric (28.3%) and duodenal (20%) perforations. Diffuse peritonitis was present in 91.7%. Post-operative complications occurred in 35.3%, predominantly surgical site infection (23.5%). Overall mortality was 15%. Mortality was higher with organ failure (45% vs. 0%), malignancy (60% vs. 10.9%), and colonic perforation (80%). Fecal exudate showed the highest mortality (71.4%) (P<0.0001). MPI demonstrated strong predictive performance with an area under the curve of 0.964. At a cutoff ≥26, sensitivity was 88.9%, specificity was 94.1%, positive predictive value was 72.7%, negative predictive value was 97.9%, and accuracy was 93.3%. Conclusion: The MPI demonstrated high accuracy in predicting mortality and supported clinical risk stratification in perforated peritonitis. However, its utility in morbidity prediction was limited.
Background: Tuberculosis (TB) continues to pose a significant public health burden, particularly in resource-limited settings. Anti-tubercular therapy (ATT), though effective, is frequently associated with cutaneous adverse drug reactions (CADRs), which can lead to treatment discontinuation and adverse outcomes. Aims and Objectives: The aim of the study was to estimate the occurrence and its evolving trends clinical spectrum, and causative agents of CADRs among TB patients on ATT, and to assess associated demographic and clinical variables. Materials and Methods: A prospective observational cross-sectional study was conducted at Maharani Laxmi Bai Medical College, Jhansi, from April 2024 to March 2025. Sixty TB patients with CADRs were enrolled after meeting the inclusion criteria. Data on demographics, clinical presentation, investigations, and implicated drugs were collected and analyzed. Results: CADRs were most common among patients aged 16–30 years (43.3%), with a male predominance (55%). Most patients were from rural (65%) and lower socioeconomic backgrounds (50%). Pulmonary TB accounted for 75.01% of cases, while Extrapulmonary TB accounted for 24.99% of cases. The most frequent CADRs were morbilliform eruptions (40%), skin discoloration/ichthyosis (33.3%), and pruritus (16.7%). Severe CADRs like Stevens-Johnson syndrome/Toxic epidermal necrolysis were rare (1.7%) due to early detection and management. Isoniazid (38.3%) and clofazimine (33.3%) were the most common offending agents. Diabetes mellitus was the only comorbidity observed (6.7%). Most cases responded to symptomatic treatment and drug discontinuation. Conclusion: CADRs are prevalent among TB patients receiving ATT, especially in young adults and those with multidrug-resistant TB (MDR-TB). Isoniazid and clofazimine were frequently implicated. Early recognition and management are essential to minimize complications and ensure treatment adherence. Clofazimine being integral part of the MDR TB Regiment so accounted for increased CADRs.
Background: Non-invasive assessment of fetal main pulmonary artery (MPA) Doppler indices may provide a reliable predictor of neonatal respiratory distress syndrome (RDS). Aims and Objectives: This study aimed to evaluate the MPA Doppler indices as predictors of neonatal RDS and to correlate them with maternal and gestational factors. Materials and Methods: A prospective observational study was conducted on 100 singleton pregnancies between 28 and 37 weeks of gestation that was delivered within 72 h of Doppler assessment. MPA Doppler waveforms were recorded using standard ultrasonography protocols. Neonatal RDS was diagnosed based on clinical signs, radiographic findings, and responses to surfactant therapy. Receiver operating characteristic (ROC) analysis determined cutoff values, sensitivity, and specificity, while logistic regression identified independent predictors of RDS. Results: Among the 100 neonates, 24 developed RDS. Pulsatility indice (PI) was significantly lower (1.48±0.33 vs. 1.66±0.36, P=0.037), acceleration time (AT) shorter (59.33±7.52 vs. 66.89±7.06 ms, P<0.001), ejection time (ET) longer (227.25±25.72 vs. 204.79±19.62 ms, P<0.001), and AT/ET ratio reduced (0.258±0.036 vs. 0.325±0.035, P<0.001) in the RDS group. ROC analysis showed gestational age ≤236 days (sensitivity 83.33%, specificity 93.42%) and AT/ET ratio ≤0.29 (sensitivity 87.5%, specificity 88.16%) as the strongest predictors. Maternal age >26 years, PI ≤1.7, AT ≤56 ms, and ET >210 ms had moderate predictive values. Logistic regression confirmed AT/ET ratio and gestational age as independent predictors of RDS (area under the curve 0.908 and 0.921, respectively). No significant correlation was found between gestational age and AT/ET ratio (P=0.32). Conclusion: Fetal MPA Doppler assessment, particularly the AT/ET ratio combined with gestational age, is a reliable, non-invasive predictor of neonatal RDS. Multicenter studies are needed to validate the cutoff values and long-term outcomes.
Gallbladder neuroendocrine neoplasms (GB-NENs) are extremely rare, forming about 0.5% of all neuroendocrine tumors (NETs) and roughly 2% of gallbladder malignancies. Their clinical presentation is often vague and mimics common conditions such as gallstones or adenocarcinoma, which makes diagnosis difficult before surgery. This retrospective review was conducted at a tertiary care hospital in Assam, India, covering cholecystectomy specimens from January 2014 to December 2023. Out of 6,532 specimens examined, 191 were cases of gallbladder carcinoma, and only 3 (1.57%) were identified as GB-NENs through histopathology and immunohistochemistry (IHC). Clinical details, pathological findings, treatment, and outcomes of these patients were studied. All three patients were women, with a mean age of 49 years. Abdominal pain was the most common presenting symptom. The first case was an incidental finding of a NET Grade I following cholecystectomy for cholelithiasis. The second case presented with jaundice and was diagnosed as a Well-Differentiated NET Grade III showing lymphovascular invasion and nodal metastasis; she underwent surgery followed by chemotherapy. The third case was a poorly differentiated neuroendocrine carcinoma involving the gallbladder neck and peritoneum with extensive lymphadenopathy; she later developed cervical lymph node metastasis within 11 months and is currently on chemotherapy. Gallbladder tumors occasionally include this rare but clinically important subtype. Because the symptoms and imaging findings are non-specific, diagnosis is usually made only after surgery, with histopathology and IHC remaining the definitive tools. Poorly differentiated forms tend to metastasize early and carry a poor prognosis, though surgery continues to be the most effective treatment option. Greater clinical awareness, a multidisciplinary approach, and further studies on targeted therapies are vital for improving outcomes in GB-NENs.
Peri-intubation hypoxia remains a major cause of airway-related morbidity and mortality during anesthesia and critical care airway management. Critically ill patients, obese individuals, pregnant women, and patients with limited physiological reserve are especially vulnerable to rapid oxygen desaturation during the induction of anesthesia and tracheal intubation. Contemporary airway management increasingly focuses on optimization of oxygenation throughout the peri-intubation period rather than conventional pre-oxygenation alone. Current strategies include head-up positioning, non-invasive ventilation, high-flow nasal oxygen, apneic oxygenation, delayed sequence intubation, and peri-intubation physiological optimization. Emerging evidence supports multimodal oxygenation strategies to prolong safe apnea time and reduce severe desaturation events. This review summarizes the pathophysiology of peri-intubation hypoxia, critically evaluates current preventive strategies, and discusses future directions in peri-intubation oxygenation practices.
Cushing’s disease (CD) is a form of Cushing’s syndrome, caused by an adrenocorticotropic hormone-secreting pituitary tumor. CD typically presents as weight gain, headache, and fatigue, and is associated with hypertension, diabetes mellitus, and psychiatric disorders. Transsphenoidal surgery (TSS) is the primary treatment, though relapse occurs in up to 18% of patients, typically within 4 years. We present a woman in her late 40s with a long-standing CD who initially achieved biochemical remission following TSS. However, she experienced an early recurrence within 3 months. Post-operative magnetic resonance imaging showed an empty sella with a small enhancing focus, suggestive of residual disease. She declined repeat surgery and underwent stereotactic radiotherapy, conventional radiotherapy, and medical therapies. These failed to maintain remission, and she subsequently developed hypopituitarism following radiotherapy. This case illustrates the chronic nature of CD and the risk of early recurrence despite remission. Managing recurrent CD is complex and requires an individualized, multidisciplinary approach that integrates psychosocial and medical care to optimize outcomes.
Background: Triple-negative breast carcinoma (TNBC) lacks established hormonal targets, limiting therapeutic options. Androgen receptor (AR) expression has been proposed as a potential biomarker, though its clinicopathological relevance remains unclear. Aims and Objectives: This study evaluated the prevalence of AR expression in TNBC and its association with clinicopathological parameters. Materials and Methods: This retrospective cross-sectional study included 52 patients with TNBC treated at Tirunelveli Medical College (2017–2019). Primary TNBC cases with adequate formalin-fixed, paraffin-embedded tissue were included, while cases receiving neoadjuvant therapy or with inadequate tissue were excluded. AR expression was assessed by immunohistochemistry (≥1% nuclear staining=positive). Tumors were classified and graded according to the World Health Organization Classification of Breast Tumors and the Nottingham-modified Bloom–Richardson system, respectively. Associations with clinicopathological variables were analyzed using appropriate statistical tests, with P<0.05 considered significant. Results: AR expression was identified in 22 of 52 cases (42%). The mean age was 52.41±11.49 years in AR-positive cases and 49.80±10.76 years in AR-negative cases (P=0.701). Mean tumor size was comparable between AR-positive (4.04±2.06 cm) and AR-negative tumors (4.31±2.77 cm; P=0.405). No significant association was observed between AR expression and histological tumor type (P=0.722), tumor grade (P=0.332), tumor necrosis (P=0.879), stromal response (P=0.297), or lymph node status (P=0.281). Conclusion: AR expression was present in 42% of TNBC cases and showed no significant association with clinicopathological parameters.
