Background Gestational diabetes mellitus (GDM) constitutes a significant public health challenge in India, particularly impacting pregnant women and posing risks to both maternal and fetal health. Despite the growing prevalence of GDM, limited qualitative evidence is available regarding the health-seeking behaviors of women in Odisha. This study aimed to explore the health-seeking behaviors among women diagnosed with GDM. Methods A descriptive exploratory research design was used at a tertiary care hospital in Odisha, India. Women diagnosed with GDM were recruited through purposive sampling, excluding those with pre-existing chronic conditions. One-on-one interviews were conducted with 21 participants in the Odia language, audio-recorded, transcribed verbatim, and analyzed using thematic analysis supported by NVivo software, version 14 (trial version; Lumivero, Denver, CO, USA). Trustworthiness was ensured through member checking, prolonged engagement, and detailed contextual descriptions. Results Thematic analysis was performed for the transcripts, and six key themes emerged from the analysis: emotional responses to diagnosis, including fear, guilt, and denial; inconsistent information delivery from healthcare providers; expectations for empathetic care, continuity of care, and peer support; positive changes in health behaviors, such as improved dietary practices, increased physical activity, and heightened health awareness; barriers to healthcare access, which included transportation challenges, financial constraints, and cultural or linguistic obstacles; and determinants of health-seeking behavior shaped by family support, cultural beliefs, competing responsibilities, and perceptions of medical interventions. Family encouragement was found to facilitate adherence, while misconceptions and logistical barriers hindered effective management. Conclusion This study identified key themes surrounding health-seeking behaviors, specifically emotional responses to diagnosis, the perceived adequacy of information, expectations of healthcare providers, positive lifestyle modifications, barriers to accessing care, and the overarching determinants of health-seeking behavior. To optimize patient outcomes, these dimensions must be actively addressed by healthcare personnel and systematically integrated into healthcare services.
Workplace violence against doctors has become an increasingly important concern in hospital settings, particularly in emergency departments and high-volume tertiary hospitals where clinical urgency, emotional distress, overcrowding, and resource limitations commonly intersect. Patients' relatives and companions represent a particularly important group in this context because they often function as caregivers, advocates, financial decision-makers, and intermediaries between the patient and the healthcare system. Their aggressive reactions may be triggered by fear, uncertainty, poor prognosis, perceived delays, unmet expectations, or inadequate communication. This narrative review synthesizes current evidence on violence against doctors by patients and their relatives in hospital settings, with emphasis on risk factors, communication failures, psychological and system-level drivers, consequences, and prevention strategies. A structured Scale for the Assessment of Narrative Review Articles (SANRA)-guided narrative methodology was used to review relevant literature from PubMed/MEDLINE, ScienceDirect, SpringerLink, BMJ Open, PubMed Central, Google Scholar, and institutional sources such as the World Health Organization. Included sources addressed workplace violence, patient or relative aggression, emergency department violence, doctor-patient communication, burnout, and mitigation strategies. The evidence indicates that aggression toward doctors is usually multifactorial and can be understood through both organizational behavior and patient-provider conflict perspectives. From an organizational perspective, violence may arise when overcrowding, staff shortages, long waiting times, limited resources, weak security systems, and inadequate reporting mechanisms create a high-pressure clinical environment. From an interpersonal conflict perspective, aggression may develop when relatives' expectations, emotional distress, and need for information are not aligned with clinical realities, triage priorities, or available hospital resources. Communication failure appears to be one of the most modifiable drivers of aggression, particularly when relatives receive inconsistent or insufficient information about diagnosis, prognosis, delays, or clinical priorities. The consequences of violence extend beyond immediate harm and include anxiety, burnout, reduced morale, defensive medical practice, disruption of team functioning, underreporting, and compromised patient safety. Overall, violence against doctors by patients and their relatives should be approached as both an occupational safety issue and a healthcare quality problem. Effective prevention requires integrated hospital-level strategies, including communication training, structured family updates, visible triage explanations, waiting-time communication, environmental safety measures, incident reporting systems, leadership accountability, and post-incident support. Future research should examine patients' relatives as a distinct group, particularly in emergency departments, tertiary hospitals, and resource-limited healthcare settings.
The competition for highly desired residency training positions in certain medical specialties has become intense. Annually in the US, there are multiple instances of an inability of the National Residency Match Program (NRMP) to accommodate each medical student's desire for a seat in their residency of interest. Residency applicant interviews since the COVID-19 pandemic are virtual, initially for disease prevention, but now for cost savings (to both the institution and the applicants). This intense competition for positions has led to sophisticated measures by some applicants to manipulate the system by use of artificial intelligence robots (AI bots) during these virtual interviews. These AI bots gather information quickly in response to an interviewer's question and allow the applicant to seamlessly respond. Here, there is not only a consideration of cheating during the interview, but a question of whether such behavior will affect the critical thinking abilities of future physicians. Academic misbehavior through use of AI during a residency interview may portend dishonesty in a successful applicant's future medical practice. We present this commentary as a cautionary tale to those involved in the selection process regarding residency training slots.
Bundibugyo virus disease (BVD) is a high-consequence filovirus infection with no approved vaccine or specific therapeutic, making early detection, supportive care, infection prevention, and coordinated public health action essential. This editorial is a rapid narrative synthesis of publicly available outbreak information from the WHO Disease Outbreak News, the Centers for Disease Control and Prevention (CDC) reports, the Uganda Ministry of Health updates, and the WHO African Region situation materials. We prioritized official reports because the event was rapidly evolving and because case counts, contact-tracing indicators, and health-zone classifications were being updated as surveillance and laboratory capacity expanded. This editorial summarizes the May-July 2026 BVD outbreak involving the Democratic Republic of the Congo (DRC) and Uganda and highlights public health lessons for cross-border preparedness. We reviewed official WHO, CDC, Uganda Ministry of Health, and WHO African Region reports, with data reviewed through July 3, 2026. WHO was alerted on May 5, 2026, to a high-mortality illness cluster in Mongbwalu Health Zone, Ituri Province, DRC. The DRC and Uganda declared outbreaks on May 15, 2026, and the WHO determined that the event constituted a public health emergency of international concern. Response measures included surveillance, laboratory expansion, isolation and supportive care, contact tracing, infection prevention and control, safe burial, community engagement, cross-border coordination, and preparation for ethically approved trials of candidate countermeasures. This outbreak shows that border-linked surveillance must be integrated with first-contact facility readiness, health-worker protection, trusted community engagement, continuity of essential services, complete contact follow-up, and trial-ready systems rather than reliance on generic Ebola plans or indiscriminate travel restrictions.
Aims and objectives Creative writing has already been utilized within the context of care and rehabilitation of patients suffering from various mental and physical conditions, yielding positive outcomes. The aim of this study is to examine whether and how the psychosomatic state of chronic pain patients is affected by their engagement with creative writing. Methodological design The study employed a non-randomized design and used a longitudinal controlled quasi-experimental design with two parallel groups assessed at three timepoints: pre-intervention (T1), mid-intervention (T2), and post-intervention (T3). Ethical issues and approval Participants provided written informed consent, and the study was approved by the Scientific Council of the University General Hospital of Alexandroupolis (approval number: 50535/18-10-2023). Research methods and interventions This controlled longitudinal quasi-experimental study included 120 adults with chronic pain, allocated to an intervention group (n = 60) or a control group (n = 60), and compared the effects of a creative writing intervention against a waitlist control on self-assessed pain severity, quality of life, anxiety, and self-rated health, assessed at three timepoints (T1 = baseline; T2 = mid-point; T3 = post-intervention). Results Over an observation period of two weeks, the control group showed near-zero change on every outcome: pain, anxiety, functional impairment, and health. The intervention group, by contrast, showed a progressive improvement in self-rated health and a meaningful decrease in anxiety, while pain severity and functional impairment remained broadly stable. Conclusions The intervention was associated with significant reductions in anxiety and depression and meaningful improvements in self-rated health by the end of the observation period. Pain severity itself did not change significantly at the group level, but the way pain related to other aspects of quality of life differed markedly between the two groups.
Background Refractive error is a widespread cause of decreased visual acuity, which can impact academic success, work productivity, and quality of life. Uncorrected visual acuity (UCVA) provides baseline information regarding refractive status before optical correction. The purpose of this study was to compare UCVA between adults aged 18-25 years and 38-45 years. Methodology This cross-sectional study was conducted in the Department of Optometry at the NSHM College of Management and Technology, Durgapur, West Bengal, India, between November 2025 and April 2026. A total of 300 participants undergoing refractive assessment were enrolled, comprising two equal age groups. Group A consisted of 150 individuals aged 18-25 years, and Group B consisted of 150 individuals aged 38-45 years. UCVA was measured using a Snellen chart and subsequently converted to logMAR values for statistical analysis. Each participant underwent a comprehensive refraction assessment and was included in the study only if their best-corrected visual acuity was 6/9 or better. Welch's independent-samples t-test was applied to compare UCVA between the groups, while categorical variables were analyzed using the chi-square test. Results The mean UCVA for the right eye was significantly poorer in the 18-25-year group than in the 38-45-year group (0.249 ± 0.199 vs. 0.142 ± 0.117 logMAR; mean difference: 0.107; 95% confidence interval (CI): 0.070-0.144; p < 0.001). Left eye UCVA was poorer in the younger group (0.187 ± 0.199 vs. 0.136 ± 0.120 logMAR; mean difference: 0.051; 95% CI: 0.014-0.088; p = 0.008). There was no significant difference in gender distribution between the groups (p = 0.160). The distribution of refractive errors varied significantly between the groups (p < 0.001), and compound myopic astigmatism was more prevalent in the 18-25-year group (149 eyes, 49.7%) compared with the 38-45-year group (1 eye, 0.3%). Conclusions The UCVA scores of participants aged 18-25 years were significantly lower than those of the 38-45-year-old participants. The poorer UCVA was mainly associated with higher compound myopic astigmatism, highlighting the need for regular refractive screening and timely optical correction among young adults.
Background Hemorrhoidal disease is one of the most common benign anorectal disorders encountered in surgical practice. Although various surgical modalities are available for grade III and IV hemorrhoids, Milligan-Morgan hemorrhoidectomy remains the gold standard treatment. However, postoperative pain is a major complication associated with this procedure. Therefore, hemorrhoidectomy using the harmonic scalpel (HS) has gained attention because of its potential to reduce tissue injury and postoperative pain. Methods This prospective single-center observational study included 112 patients with grade III and IV hemorrhoids who underwent hemorrhoidectomy using the conventional technique (n = 59) or the harmonic scalpel (n = 53) at a tertiary teaching hospital between December 2024 and May 2026. Approval was obtained from the Institutional Ethics Committee of Sri Ramachandra Institute of Higher Education and Research (approval number: CSP-MED/24/OCT/110/327), and written informed consent was obtained from all the participants. The study aimed to compare the efficacy of hemorrhoidectomy using the harmonic scalpel with the conventional technique in terms of perioperative outcomes. The primary outcomes included intraoperative bleeding, operating time, and postoperative pain, whereas secondary outcomes included the duration of hospital stay and postoperative urinary retention. Statistical analysis was performed, and a p-value of <0.05 was considered statistically significant. Results A significant reduction in operating time (<0.001), intraoperative blood loss (<0.001), postoperative pain (<0.001), postoperative urinary catheterization (0.018), and hospital stay (<0.001) was noted in the group undergoing hemorrhoidectomy using the harmonic scalpel compared with the conventional group. Conclusion Patients undergoing hemorrhoidectomy using the harmonic scalpel demonstrated a significant reduction in intra- and postoperative complications compared with the conventional group, suggesting greater efficacy in the management of grade III and IV hemorrhoids.
Hepatic adrenal rest tumours (HARTs) are rare benign lesions arising from ectopic adrenocortical tissue. Their radiological resemblance to hepatocellular carcinoma (HCC) presents a significant diagnostic challenge. We report a case of HART in a woman in her 60s with chronic hepatitis B (CHB) without cirrhosis who underwent surgical resection following a preoperative diagnosis of HCC. The patient, who was of Filipino descent, was being treated with entecavir and underwent a routine six-monthly HCC surveillance, during which a lesion of concern was identified on ultrasound. Liver synthetic function and serum transaminases were within normal limits, hepatitis B viral load was undetectable, and serum alpha-fetoprotein was normal. MRI demonstrated a 14-mm fat-containing lesion in segment VI according to the Couinaud classification, exhibiting homogeneous arterial phase hyperenhancement and portal venous washout, findings considered radiologically consistent with HCC. Following multidisciplinary review, she underwent laparoscopic hepatectomy. Histopathological examination revealed a well-circumscribed lesion composed of compact nests of uniform cells with regular round nuclei and finely vacuolated clear cytoplasm. Immunohistochemistry demonstrated positivity for inhibin and Melan-A, with negative staining for PAX8, HepPar-1, AE1/AE3, S100, HMB45, synaptophysin, and chromogranin, establishing the diagnosis of HART. This case highlights the difficulty in distinguishing HART from HCC based on imaging alone, particularly in patients with established HCC risk factors. Recognition of HART as a potential differential diagnosis for hypervascular hepatic lesions may support more informed multidisciplinary evaluation and management.
Accurate assessment of fertility rates and their long-term trends is essential for understanding reproductive dynamics, anticipating the healthcare and socioeconomic consequences of demographic change, and informing family planning and population policies. The aim of this study was to investigate long-term trends in the general fertility rate (GFR) in Greece using nationwide population data. Official national data on annual live births and the female population aged 15-44 years were obtained from the Hellenic Statistical Authority for the period 1956-2024. The GFR was calculated as the annual number of live births per 1,000 women of reproductive age (WRA). An age-standardized GFR (ASGFR) was also calculated for each study year using the 2013 European Standard Population. Temporal trends were analyzed using Joinpoint regression to estimate annual percent changes (APCs) and corresponding 95% confidence intervals (95% CIs). The GFR declined during 1956-1980 (APC = -0.3, 95% CI: -0.4 to -0.2), with two historic peaks recorded in 1959 and 1967, when it reached 81.6 and 80.7 births per 1,000 women aged 15-44 years, respectively. Over the subsequent two decades, the GFR declined further (1980-1989: APC = -4.7, 95% CI: -5.5 to -4.2; 1989-1999: APC = -1.2, 95% CI: -1.6 to -0.7). From 1999 to 2009, the GFR increased (APC = 2.1, 95% CI: 1.7 to 2.6). Thereafter, it entered a renewed period of decline, reaching a historic low of 39.4 births per 1,000 women aged 15-44 years in 2024, representing a 25% decrease compared with 2009. This decline was characterized by two periods of significant reduction, during 2009-2013 (APC = -3.7, 95% CI: -5.4 to -2.0) and 2021-2024 (APC = -5.0, 95% CI: -8.1 to -3.0), with a period of relative stability between 2013 and 2021. Following a period of stability during 1956-1963, the ASGFR increased during 1963-1967 (APC = 2.6, 95% CI: 1.3 to 4.1) and subsequently declined during 1967-1999. The rate increased again during 1999-2009 (APC = 2.3, 95% CI: 1.9 to 2.7), declined during 2009-2013 (APC = -3.4, 95% CI: -5.9 to -0.7) and 2021-2024 (APC = -4.4, 95% CI: -6.9 to -1.8), whereas it showed a modest upward trend during 2013-2021 (APC = 0.9, 95% CI: 0.2 to 1.7). During 2009-2024, approximately 70% of the overall decline in the GFR was attributable to declining fertility rates and 30% to changes in the age composition of women of reproductive age. However, the contribution of these factors shifted over time: alterations in the age distribution of women of reproductive age accounted for most of the decline during 2009-2021, whereas fertility decline became the predominant driver during 2021-2024. This nationwide study demonstrates a sustained long-term decrease in the GFR in Greece over nearly seven decades, culminating in a historic low in 2024, despite a temporary recovery between 1999 and 2009. The recent GFR downward trend observed from 2009 to 2024 was the result of fertility decline, exacerbated by unfavorable shifts in the age structure of women of reproductive age.
Background Preoperative templating is an important component of surgical planning in knee arthroplasty. In medial unicompartmental knee replacement (UKR), accurate tibial component sizing can be challenging due to limited surgical exposure and the risk of posterior cortical injury. This study aimed to evaluate the accuracy and interobserver reliability of preoperative templating using templating software in predicting tibial component size. Methods A retrospective observational study was conducted including 69 patients who had undergone medial UKR between January 2023 and December 2024. Two orthopaedic specialty doctors independently templated preoperative lateral knee radiographs using TraumaCad software (Brainlab, Munich, Germany), blinded to the actual implanted component size and to each other's assessments. Predicted sizes were compared between observers and against the implanted components. Interobserver reliability was assessed using the intraclass correlation coefficient (ICC) with a two-way random effects model for absolute agreement and weighted Cohen's kappa with quadratic weights. Results Exact agreement between observers was observed in 39 of 69 cases (56.5%), increasing to 68 of 69 (98.6%) within ±1 size. Observer 1 predicted the exact implanted size in 35 cases (50.7%), improving to 60 cases (87.0%) within ±1 size. Observer 2 demonstrated higher accuracy with exact prediction in 42 cases (60.9%) and 66 cases (95.7%) within ±1 size. Interobserver reliability was almost perfect with an ICC of 0.82 (95% CI: 0.72-0.88) and a weighted kappa value of 0.82. Bland-Altman analysis revealed minimal systematic bias between observers (mean difference 0.33 sizes). Observer 1 showed systematic oversizing compared to actual implants (mean bias +0.45 sizes, p<0.001), while Observer 2 demonstrated no significant bias (mean bias +0.12 sizes, p=0.19). Conclusion Preoperative templating using TraumaCad demonstrated almost perfect interobserver reliability and good-to-excellent accuracy within a clinically acceptable range. It represents a useful adjunct in surgical planning for medial UKR. Future studies comparing templating performance across different software platforms would be valuable.
Cigarette smoking remains a major modifiable contributor to cardiovascular morbidity and mortality through mechanisms involving systemic inflammation, oxidative stress, endothelial dysfunction, dyslipidemia, and hematologic abnormalities. Although the long-term cardiovascular benefits of smoking cessation are well-established, the temporal pattern of biologic recovery following cessation remains incompletely understood. This systematic review synthesized current evidence regarding the reversal of cardiovascular risk biomarkers after smoking cessation, with emphasis on the timing and magnitude of biomarker normalization. A comprehensive search of PubMed, Embase, Scopus, and Cochrane CENTRAL identified studies published between January 1990 and May 2024 evaluating biomarker changes following smoking abstinence. Eligible studies included randomized controlled trials, prospective clinical studies, and observational investigations involving adults who achieved smoking abstinence for at least seven days. Risk of bias was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool and the Risk of Bias in Nonrandomized Studies-of Interventions (ROBINS-I) instrument, and findings were synthesized narratively because of methodological heterogeneity. Ten studies comprising 2,750 participants met the inclusion criteria. Biomarker recovery followed a staged temporal pattern, with oxidative stress markers improving within one to two weeks, inflammatory biomarkers declining over approximately two to 12 weeks, and lipid and hematologic parameters improving more gradually over three to eight months. However, substantial heterogeneity in study design, cessation interventions, biomarker selection, and follow-up duration limited direct cross-study comparability. Adjunctive interventions, including antioxidant supplementation and exercise, appeared to enhance biomarker recovery in selected populations. Overall, smoking cessation was associated with progressive improvement in multiple cardiovascular risk pathways, supporting its critical role in cardiovascular prevention and highlighting the potential value of biomarker-guided approaches in future risk-reduction strategies.
Gangrenous cholecystitis with peritonitis in elderly, high-risk patients carries substantial perioperative risk, particularly when compounded by multiple comorbidities, coagulopathy, and sepsis. General anesthesia in such patients is associated with increased hemodynamic instability and postoperative morbidity. Regional anesthesia combined with procedural sedation has been proposed as a safer alternative in selected high-risk surgical candidates. We report the case of an 81-year-old woman who presented with cholecystitis complicated by diffuse peritonitis. Her medical history included cerebral ischemic stroke, diabetes mellitus, stage 3 chronic kidney disease, and arterial hypertension. On admission, she was septic, with elevated C-reactive protein (44 mg/L) and procalcitonin (10.9 ng/mL), hypoalbuminemia (2.5 g/dL), and a deranged coagulation profile (INR 1.9). Given the high anesthetic risk associated with general anesthesia, a regional strategy was adopted, combining an ultrasound-guided intertransverse process (ITP) block (T7-T8/T8-T9, ropivacaine 0.2%, 20 mL) with bilateral deep rectus sheath (DRS) blocks (ropivacaine 0.2%, 20 mL each side). Surgery began 30 minutes after block placement under sedation with dexmedetomidine (1 mcg/kg bolus followed by 1.2 mcg/kg/h infusion) and ketamine (0.25 mg/kg/h, total dose 40 mg). Laparoscopic cholecystectomy was completed in 90 minutes, with hemodynamics remaining stable throughout (mean arterial pressure approximately 65 mmHg). The patient emerged from the operating room sedated but breathing spontaneously, without the need for airway instrumentation, and was admitted to the intensive care unit for monitoring. She was discharged from the intensive care unit after 20 hours in stable condition and discharged home on postoperative day 8. Combined ultrasound-guided ITP and DRS blocks, supplemented with dexmedetomidine-ketamine sedation, provided effective anesthesia for emergency laparoscopic cholecystectomy while avoiding general anesthesia in an elderly, septic, high-risk patient with coagulopathy. This approach may represent a viable strategy to reduce perioperative risk in similarly frail surgical candidates.
Introduction Critical thinking and clinical reasoning are two core competencies essential for medical students in their evolution from passive learners to proficient future clinicians. These competencies require higher-order cognitive skills which cannot be accomplished through conventional lectures. In contemporary medical education, team-based learning (TBL) has emerged as an active innovative instructional strategy which promotes active participation, accountability, problem-solving, and higher-order thinking. The California Critical Thinking Skills Test (CCTST) assesses critical thinking, while the Script Concordance Test (SCT) measures clinical reasoning under uncertainty. The study aimed to evaluate the effectiveness of TBL in improving critical thinking and clinical reasoning among first-year MBBS students. Method An educational interventional study was conducted among 152 first-year MBBS students during a TBL session which included their pre-class preparation, Individual Readiness Assurance Test (IRAT), Team Readiness Assurance Test (TRAT), and application exercises with immediate facilitator feedback. To assess critical thinking, a 20-item questionnaire called the Critical Thinking Assessment Test (CTAT) on adrenal cortex disorders was constructed based on the domains described in the CCTST. To measure clinical reasoning, a 30-item questionnaire was developed on the same topic based on SCT. The two questionnaires which were developed by the investigator and validated by an expert panel were used before and after the TBL session. Result A substantial improvement was observed in SCT (Cohen's d=0.89) in comparison to CTAT scores (Cohen's d=0.73) after the TBL session. The TBL intervention strengthened the relationship between clinical reasoning (SCT) and critical thinking (CTAT) transforming a weak correlation (r=0.163; p=0.045) into a moderate, statistically significant correlation (r=0.369; p<0.0001). Student performance increased progressively from IRAT (3.27±1.68) to TRAT (8.97±0.87) to application exercises (11.36±1.35) (p<0.0001). Conclusion The study indicates that the implementation of TBL sessions in the early stage of medical training of students can bridge the gap between basic science concepts and clinical applications enhancing both critical thinking and clinical reasoning.
Hyalinizing trabecular tumors (HTTs) of the thyroid are rare benign neoplasms that often mimic papillary thyroid carcinoma (PTC) and medullary thyroid carcinoma (MTC) on cytology, creating significant diagnostic challenges. We present a case of a 38-year-old female with a 4.2 cm right thyroid nodule. Fine-needle aspiration biopsy revealed overlapping nuclei, grooves, pseudoinclusions, and stromal hyaline material, which are suspicious features of malignancy (Bethesda category V). The patient underwent total thyroidectomy. Histology showed a well-encapsulated trabecular neoplasm with extensive stromal hyalinization. Immunohistochemistry was thyroglobulin and thyroid transcription factor-1 positive, and calcitonin, chromogranin A, and carcinoembryonic antigen negative, confirming HTT. Despite these tumors being, for the most part, benign, their cytological overlap with PTC and MTC usually results in misdiagnosis and overtreatment, including unnecessary total thyroidectomy. The lack of uniform cytological or molecular markers also renders preoperative diagnosis more challenging. The current case outlines the diagnostic dilemma of HTTs and the need for improved diagnostic tools to guide appropriate management and prevent overtreatment of this otherwise benign tumor.
Anatomic malformation as seen in subclavian steal syndrome leads to an alteration in the body's autonomic regulatory pattern, influencing varying physical manifestations. The autonomic nervous system provides situational regulatory feedback to the body, maintaining the body's desired point of homeostasis. We report the case of a 68-year-old male who initially came in with X-rays indicating retrolisthesis and calcifications in his carotids. A left-sided carotid bruit was also noted, as well as right-sided upper extremity weakness. Continued imaging studies indicated structural changes to his cervical regions and continued calcifications in the remainder of his arterial supply branching off of his carotid arteries. The patient's denial of surgical intervention led to treatments focused on symptomatic control until more conclusive data could be collected and interpreted.
Haglund syndrome has become an important consideration in the differential diagnosis of posterior heel pain. It results from mechanical conflict between a prominent posterosuperior calcaneal tuberosity, the Achilles tendon, and the surrounding bursae. We report the case of a 45-year-old woman presenting with chronic posterior heel pain associated with a visible deformity of the posterior ankle. Imaging demonstrated a prominent calcaneal tuberosity, Achilles tendinopathy, and mild retrocalcaneal bursitis. The clinical presentation and imaging findings are discussed, highlighting the role of imaging techniques in evaluating posterior heel pain, confirming the diagnosis of Haglund syndrome, and excluding other causes of posterior heel pain, including inflammatory enthesitis associated with spondyloarthropathies.
Rhinophyma is a chronic cutaneous condition secondary to rosacea that primarily affects the nose, leading to a bulbous and enlarged appearance. We report two cases of rhinophyma in 65- and 76-year-old men with long-standing rosacea evolving for more than 10 years. Both patients presented with progressive nasal enlargement, erythema, and nodular hypertrophy that had worsened over the previous five to seven years, leading to significant cosmetic and psychosocial impairment. The diagnosis was clinical. Surgical treatment was performed in both cases, including electrosurgical excision in one patient, allowing effective removal of hypertrophic tissue with good hemostasis and nasal remodeling. Postoperative care combined light-emitting diode photobiomodulation with adapted wound dressings and topical healing agents according to the stages of wound healing. Outcomes were favorable, with marked aesthetic improvement, reduction of nasal hypertrophy, and improved quality of life in both patients. Rhinophyma may significantly impair quality of life because of its progressive and disfiguring nature. Early management of rosacea with appropriate medical treatment is essential to limit progression; however, advanced hypertrophic forms may require therapeutic escalation to surgical approaches such as electrosurgery. In such cases, electrosurgical remodeling associated with appropriate postoperative wound care can provide favorable functional and aesthetic outcomes.
Mycosis fungoides (MF) is the most common primary cutaneous T‑cell lymphoma, usually affecting adults aged 50-60 years; pediatric presentation is rare. We report a 12‑year‑old patient whose course spanned five years; skin lesions began at age 8, were misdiagnosed and treated as inflammatory dermatosis with topical steroids for four years. At age 12, B‑symptoms, lymphadenopathy and organomegaly led to the diagnosis of MF Stage IA (T1bNxM0B0) and synchronous Hodgkin lymphoma (HL) Stage IVB, with an Epstein-Barr virus (EBV) viral load of 2.5 log₁₀ copies/mL. Treatment with three cycles of CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) + pembrolizumab due to drug availability, followed by six cycles of PC‑AVBE (prednisone, cyclophosphamide, doxorubicin, vincristine, bleomycin, and etoposide) and radiotherapy, achieving complete remission. This case highlights diagnostic challenges, immune dysregulation, and adapted treatment in resource‑limited settings.
The triangle of Brocq and Mouchet is a clinically significant arteriovenous region on the anterior surface of the heart, formed by the anterior interventricular artery (AIV), circumflex artery (Cx), and great cardiac vein (GCV). Despite its relevance in cardiac surgery and interventional cardiology, detailed anatomical characterization of this region remains limited. This study aimed to evaluate the presence, morphological variations, and vascular relationships of the triangle of Brocq and Mouchet in human cadaveric hearts, with emphasis on its clinical significance.  A descriptive cadaveric study was conducted on 30 adult human hearts obtained from routine anatomical dissections at Sri Ramachandra Institute of Higher Education and Research (Deemed to be University) (SRIHER (DU)). Specimens with intact coronary vasculature were included. Detailed microdissection was performed to identify the LAD, Cx, and GCV. The arteriovenous triangle was first assessed for its presence and morphology. Based on the anatomical configuration formed by the AIV, Cx, and GCV, the triangle was classified into five morphological types: closed, inferiorly open, superiorly open, completely open, and absent. The relationship of the GCV with the LAD and Cx was recorded as superficial, deep, crossing, or parallel. Additional arterial components, including median and diagonal branches, were documented.  The triangle was present in 28 (93.3 %) specimens. The closed type was the most frequent pattern (15 (50%) specimens), followed by the inferiorly open type (12 (40%) specimens), the superiorly open type (1 (3.3%) specimen), and absence of the triangle (2 (6.7%) specimens). No completely open type was observed. The GCV was predominantly deep to the LAD (16 (59.3%) specimens) and superficial to the Cx (21 (72.4%) specimens), with mixed relationships observed in 15 (50%) specimens. Additional arterial components were identified as the median artery in 11 (39.3%) specimens and diagonal branches in 8 (28.6%) specimens, with most structures located superficial to the GCV in 17 (60.7%) specimens. The triangle of Brocq and Mouchet showed high prevalence and considerable anatomical variability in morphology and vascular relationships. These variations have important implications for coronary interventions, including catheterization, coronary artery bypass grafting (CABG), and electrophysiological procedures. A comprehensive anatomical understanding of this region is essential for improving procedural safety, minimizing iatrogenic complications, and supporting better clinical outcomes.
A hydatid cyst is caused by Echinococcus granulosus. It is transmitted to humans via the feco-oral route. It occurs mostly in the liver or lungs. Intracranial occurrence is a very infrequent phenomenon. This review aimed to provide an insight into the clinicopathological spectrum of primary intracranial hydatid cyst and its management in Pakistani patients. Databases (PubMed and Google Scholar) and national journals were searched using predefined keywords from their inception until October 31, 2025. All case reports (CR), case series (CS), and original articles that satisfied the inclusion and exclusion criteria were included. A total of 11 studies were included, reporting data on 86 patients. The pooled mean age was 16.7 years, with a male predominance of 49 (59.03%). The median duration of illness was 12 (IQR: 6-12) months. The most frequently encountered symptoms were headache in 10/13 (76.90%), papilledema in 9/13 (69.20%), and motor deficit in 8/13 (61.50%). The most common location was supratentorial in 78/86 (90.70%), involving the fronto-parietal region in 21/83 (25.30%). Across the documented cases, the average diameter of the cyst was 8.81 cm. The lesion appeared hyperintense on T2 in six out of eight (75%) cases. Only 4/13 (30.79%) cases reported multiple cysts. Surgical management was opted for in all (86) cases. The Dowling technique was employed in 44 (51.16%), followed by excision in 41 (47.67%) cases. However, intraoperative cyst rupture was individually documented in three (23.07%) cases (from CR and CS). Postoperative meningitis was mentioned in only one CR. Medical therapy with albendazole was prescribed in nine (69.23%) cases, and it was continued for a mean of 28.80±28.89 weeks. The median duration of follow-up was 12 (IQR: 12-76) months. Recurrence was reported in three (23.07%) cases. Death was documented in 3/13 (23.07%) cases.  Meticulously performing the Dowling technique is safer to avoid intraoperative rupture. Subsequently, drastic complications can be prevented. Surgery, along with anti-helminthic administration, ensures the complete resolution of intracranial hydatid cysts. Long-term follow-up is necessary to investigate the course of the disease and achieve complete remission.