clinical

Epithelioid angiomyolipomas (AML) are uncommon mesenchymal neoplasms, belonging to the group of perivascular epithelioid cell neoplasms (PECOMA). Hepatic PECOMA is even rarer. It’s difficult to diagnose in preoperative by imaging, especially when the fatty component is scant or absent. The gold standard for the diagnosis is histologic examination coupled with an immunohistochemical study. Positive HMB45 immunostaining of the myoid cells is a major diagnostic feature. Herein, we report a particular case of hepatic angiomyolipoma in a middle-aged woman with no significant medical past history. The preoperative diagnosis was difficult given the absence of specific clinical manifestations, even the radiologists considered high suspicion of hepatocellular carcinoma. The final diagnosis has been made by post-operative histology coupled with an immunohistochemistry study.

Aim: This prospective study reports the acceptance testing of the Symbia Intevo Bold SPECT/CT scanner (Siemens Healthineers), recently installed at SQCCCRC, University Medical City, Muscat, Oman, before its clinical implementation.Materials and methods: The acceptance tests were performed using a Low Energy High Resolution (LEHR) collimator and Technetium-99m (Tc-99m) as the radioactive source, following the manufacturer’s protocols. The tests included physical inspection, peaking and tuning, intrinsic and extrinsic uniformity calibration, intrinsic energy resolution, and planar spatial resolution without scatter. Key performance parameters such as full-width at half-maximum (FWHM), system sensitivity, and count rate performance were evaluated.Results: All critical acceptance tests, including intrinsic energy resolution, energy calibration (symmetric curve), and extrinsic uniformity with the LEHR collimator, were completed and met the required specifications. System sensitivity and count rate performance were within the expected ranges, confirming the system’s readiness for clinical use.Conclusion: The Symbia Intevo Bold SPECT/CT system passed all performance tests successfully. The acceptance testing validated the system’s optimal performance following international standards, ensuring its suitability for clinical operations.

Introduction: Research provides a framework for Anesthesia residents who are critical thinkers who approach clinical practice with an open mind. The goal of this study was to determine current attitudes regarding performing research during residency as well as perceived obstacles to doing so. A resident physician should be ready to face the challenges of the growing technology, tons of journals published in different portals, and increasing sophistication of the health care delivery system. Practice-based learning, systems-based practices, and medical knowledge are the vital core directly affected by strong research skill set. Methods: The study was done through a survey of all 15 current residents in Vicente Sotto Memorial Medical Center Anesthesia Resident. They answered a 13 self-administered survey, which was adopted from previous similar research. Data was collected for 1 week to give time to the busy schedule of the resident. Results: Respondents cited that the lack of time in balancing clinical and research responsibilities is the most common obstacle encountered by 86.7% of respondents. Researchers feel they have inadequate research skills and a lack of time in balancing responsibilities between family and work was among the most common answers by the respondents. 2nd prevalent barrier to research during residency was a lack of mentoring. Conclusion: The top barriers to research are lack of time and inadequate access to research mentors. These barriers can be addressed to optimize the current research environment for residents. Anesthesia residents identified several critical aspects that they believe are obstacles to research. These findings can be used by programs to overcome hurdles and increase the inclusion of research into residency training.

The global menace of cancer requires supplementary treatments beyond standard medical approaches for effective medical intervention. The Ketogenic Diet (KD) composed of high fats combined with moderate proteins and low carbohydrates has become popular as a metabolic therapy for cancer. The anti-cancer mechanism of KD works through metabolic stress induction in cancer cells, reduced insulin and IGF-1 signaling pathways, improved mitochondrial function, inflammation, and immune regulation. Standard cancer treatments receive enhanced outcomes through KD synergistic action which simultaneously decreases treatment-related side effects. To achieve optimized treatment outcomes in cancer, ketogenic diet practitioners need to use personalized nutritional planning in combination with metabolic tracking and exogenous ketone supplements. It is essential to find solutions for diet adherence issues and nutrient deficiencies because they determine KD’s effectiveness as a cancer treatment. The fight against cancer needs sustained and multipronged clinical research and validation to establish the proper implementation of this method.

Methylenetetrahydrofolate Reductase (MTHFR) is an important enzyme of the folate cycle, which is required to convert 5,10-methyltetrahydrofolate into 5-methyltetrahydrofolate (5-methylTHHF). 5-methyl THF is a methyl group donor for several cellular methylation processes. It also donates methyl group for the conversion of homocysteine into methionine, the higher concentration of which is toxic. MTHFR gene C677T polymorphism is clinically important polymorphism and the variant MTHFR (A222V) enzyme has reduced activity, hence increasing the requirement for folic acid. Less conversion of folate to 5-methyl-THF due to C677T polymorphism results in a higher plasma concentration of homocysteine (hyperhomocysteinemia). Individuals having C677T polymorphism are susceptible to various diseases, including reproductive problems like male infertility, polycystic ovary syndrome, Recurrent Pregnancy Loss (RPL), Preeclampsia (PE), placental abruption, and adverse pregnancy outcomes. MTHFR C677T polymorphism mimics folate deficiency, and folate is required for DNA synthesis, repair, methylation, and proper chromosome segregation, and all these processes are important for foetal growth and normal development. Methylation and demethylation processes control the gene expression of about 45% of human genes. Impaired methylation influences the expression of genes involved in the regulation of hormones, spermatogenesis, and oogenesis. In males, oxidative stress damages sperm DNA decreases sperm motility, and may impair fertilization capability. In pregnant women, hyperhomocysteinemia increases oxidative stress and inflammation within the placenta, which causes damage to placental tissue, impairs its function, and disrupts foetal development. Further, hyperhomocysteinemia (HHcy) is embryotoxic and neurotoxic and is responsible for congenital anomalies in the foetus. This review supports the idea that MTHFR C677T polymorphism is associated with an increased risk for male infertility, PCOS, RPL, PE, and congenital anomalies. This review may provide a clue toward a better understanding of the correlation between the MTHFR C677T polymorphism and its detrimental effects on human reproductive health.

Bartholinitis, or Bartholin's gland abscess, is a relatively common gynecological condition among women of reproductive age. Its annual incidence is estimated at approximately 0.5 per 1,000 women, which corresponds to a lifetime cumulative risk of about 2%. The condition primarily affects patients between 20 and 50 years old, with a peak frequency observed between 35 and 50 years.After menopause, due to the natural involution of the gland, Bartholin's cysts and abscesses become less frequent, although they can still occur. Moreover, in women over 50, the appearance of a new mass in the gland region should prompt caution, as it may, in rare cases, indicate a carcinoma of the Bartholin's gland or an adjacent vulvar cancer. Therefore, for patients over 40 presenting with a newly emerged cyst or abscess, clinical guidelines recommend performing a biopsy or excision to rule out malignancy. We present the case of a 50-year-old woman with no significant medical history, who was urgently referred to the gynecological emergency department due to confusion, unexplained fever of 40 °C, and resistant leucorrhoea following a week of corticosteroid antibiotic therapy. Clinical examination revealed a large, tender right vulvar mass, indicative of an acute Bartholin's abscess. The patient exhibited signs of septic shock and was admitted to the ICU. Following a diagnosis of sepsis, broad-spectrum antibiotic therapy was initiated, alongside fluid resuscitation and norepinephrine support. Surgical drainage of the abscess confirmed the presence of E. coli. The patient's condition improved rapidly, and she was discharged on postoperative day 8 with no complications. This case underscores that while Bartholin's abscess is typically benign, severe complications, including septic shock, can occur—especially in patients over 50. The appearance of a new Bartholin's region mass in older women should prompt consideration of malignancy, necessitating biopsy or excision. Recent studies compare various therapeutic approaches including simple incision and drainage, Word catheter placement, marsupialization, silver nitrate application, and complete gland excision. Each method has its advantages and drawbacks, with marsupialization offering lower recurrence rates and higher patient satisfaction in many instances. 

Cardiovascular Diseases (CVDs) remain a major global health concern, necessitating accurate and comprehensive diagnostic techniques. Traditional medical imaging modalities, such as CT angiography, PET, MRI, and ultrasound, provide crucial but limited information when used independently. Image fusion techniques integrate complementary modalities, enhance visualization, and improve diagnostic accuracy. This paper presents a theoretical study of advanced image fusion methods applied to cardiovascular imaging. We explore wavelet-based, Principal Component Analysis (PCA), and deep learning-driven fusion models, emphasizing their theoretical underpinnings, mathematical formulation, and potential clinical applications. The proposed framework enables improved coronary artery visualization, cardiac function assessment, and real-time hemodynamic analysis, offering a non-invasive and highly effective approach to cardiovascular diagnostics.MSC Codes: 68U10,94A08,92C55,65T60,62H25,68T07.

Introduction: Cervical spinal cord injuries (CSIs) account for 2% - 3% of trauma cases and 8.2% of trauma- related fatalities, making them a significant cause of disability and mortality. Effective management and timely interventions are essential to improve neurological and functional outcomes. This study aimed to evaluate the outcomes of patients with CSIs and identify key predictors of neurological and functional improvement.Materials and methods: This prospective observational study was conducted over 12 months at SMS Medical College, Jaipur, involving 100 patients with CSIs from C1 to C7 vertebrae. Patients presenting within one week of injury were included. Clinical evaluation was conducted using the ASIA scoring system, and functional outcomes were assessed with the Functional Independence Measure (FIM) scale. MRI findings were analyzed to classify injuries and identify critical predictors, including the presence and extent of edema and listhesis grading.Results: Significant predictors of neurological improvement included injury type, management approach, MRI findings, extent of edema (≤ 2 vs. >2 segments), and listhesis grading. Operative management and incomplete injuries showed better outcomes. The median Barthel Index improved from 4.0 preoperatively to 7.0 at four months (p < 0.001). The mean FIM score also significantly increased from 43.25 ± 26.5 to 56.8 ± 40.75 (p < 0.05). ASIA Grades C and D demonstrated significant neurological recovery, with no grade deterioration observed.Conclusion: Age, injury type, management strategy, MRI findings, extent of edema, and listhesis grading are key predictors of outcomes in CSIs. These findings emphasize the importance of early diagnosis, timely surgical intervention, and comprehensive management in improving neurological and functional recovery. Multicentric studies with larger cohorts are recommended for broader generalizability.

The concurrent emergence of dengue fever and the COVID-19 pandemic posed significant challenges to India’s healthcare system, particularly in Western Rajasthan, a region characterized by its arid climate and unique socio-demographic conditions. This study aimed to investigate the clinical and molecular characteristics of dengue during the COVID-19 pandemic, focusing on trends, diagnostic challenges, and serotype distribution. Conducted at Dr. S.N. Medical College, Jodhpur, in 2021, the study included 550 dengue-positive patients confirmed via rapid diagnostic tests and further analyzed using Dengue NS1 antigen and IgM antibody ELISA. Molecular characterization was performed using RT-PCR for serotyping.The results revealed a male predominance (72.36%) and a higher incidence in the 21–30-year age group (39.09%). Urban areas accounted for 67.73% of cases, with significant NS1 and IgM positivity (p = 0.042 and p = 0.004, respectively). Most cases (86.91%) were managed outpatient, though IgM positivity was significantly higher among hospitalized patients (19.19%, p < 0.001), indicating severe or prolonged infections. Platelet counts were above 100,000/mm³ in 86.91% of cases, with only 0.37% showing critically low counts (< 20,000/mm³). Seasonal analysis showed a peak in October (n = 325), correlating with post-monsoon vector breeding. Serotyping identified DENV2 as the dominant strain (97.42%), associated with severe dengue manifestations, including Dengue Haemorrhagic Fever (DHF).The study highlights the dual burden of dengue and COVID-19, emphasizing the need for enhanced vector control, improved diagnostic strategies and public health interventions during overlapping outbreaks. The predominance of DENV2 underscores the importance of serotype-specific surveillance and preparedness to mitigate future dengue epidemics in the region.

Background: Acral Fibromyxoma (AFM) is a rare benign soft tissue tumour which is described as a fibromatous and myxoid tumour of skin and soft tissue. Case details: A 40-year-old  male presented to the Dermatology outpatient department with swelling over the wrist of one year duration. The swelling was associated with mild pain, and it gradually increased in size to reach its present size. Cutaneous examination revealed a 2x2 cm mobile, cystic to firm, non-tender swelling over the dorsum of the right wrist. Based on its location and clinical features, it was provisionally diagnosed as a ganglion cyst  and excision biopsy was done. Histology showed stellate-shaped cells in a myxoid background with round to oval nuclei having a small, inconspicuous nucleolus. Acral fibromyxoma presents a distinct histopathology including a myxoid stroma and spindle-shaped cells, which are essential for accurate diagnosis and management.

Introduction: The rise in cesarean section rates globally has led to a growing population of women with uterine scars, necessitating more targeted obstetric care in subsequent pregnancies. These women are faced with the decision of attempting vaginal delivery after cesarean section (VBAC) or opting for an elective repeat cesarean section. The likelihood of a VBAC depends on various factors both maternal and fetal, gathered in two known scores Grobman and Zhang, utilizing them could make VBAC successful and more widely attempted.  This study aims to validate the prognostic of these scores in a Moroccan population.Objectives:•    Validate the international predictive scores (Grobman and Zhang) for the probability of a successful VBAC in the Moroccan population.•    Explore additional criteria specific to the Moroccan population and develop a simplified VBAC score.  Results:•    Out of 2,973 women with a cesarean history, 313 attempted  TOLAC, 79% of these attempts were successful VBAC.•    The characteristics of successful VBAC included lower BMI, previous vaginal birth, lower estimated fetal weight, younger maternal age, and more favorable cervical conditions at admission.•    The Grobman and Zhang scores showed good predictive accuracy, with both models achieving 82.2% accuracy.•    When dividing women into groups based on predicted success (using both Grobman and Zhang scores), significant differences were found in success rates across different probability categories.Conclusion: Both Grobman and Zhang’s models were effective in predicting VBAC success in the Moroccan population, with a slight preference for the Zhang model. However, further research is needed to validate these models in clinical practice. It could involve developing a more population-specific model.