Anemia, particularly iron deficiency anemia (IDA), is the most common subtype, which affects over two billion individuals worldwide and is associated with various sleep disturbances in both observational and interventional studies. Although there is a growing attention towards this connection, its mechanisms, extent and treatability of have not been thoroughly investigated. This narrative review assesses the relationship between anemia, including iron deficiency anemia (IDA) and non-IDA subtypes, and various sleep-related outcomes, such as subjective sleep quality, objective sleep architecture, total sleep duration, sleep latency, sleep efficiency, restless legs syndrome (RLS), periodic limb movements (PLMs), insomnia and sleep-disordered breathing across different age groups and populations. We performed searches in PubMed/MEDLINE, Embase, Scopus, Web of Science and the Cochrane Library from the foundation of these databases until February 2026, without any language constraints. Eligible study formats encompassed cross-sectional surveys, prospective cohorts, case-control studies, randomized controlled trials (RCTs) of iron therapy that reported sleep outcomes, as well as current systematic reviews and meta-analyses. The synthesis was predominantly narrative due to significant variation among studies regarding anemia definitions, sleep assessment methodologies and population characteristics. Iron deficiency anemia is consistently linked to decreased sleep quality (higher Pittsburgh sleep quality index [PSQI] scores), reduced total sleep duration, extended sleep-onset latency, lower sleep efficiency and decreased slow-wave sleep. Restless legs syndrome (RLS) significantly manifests more often in IDA individuals, with ferritin levels of 50-75 µg/L being identified as clinically pertinent indicators. Iron supplementation, whether oral or intravenous, significantly decreases RLS severity scores and sleep disturbances in most of the assessed RCTs (moderate-certainty evidence). The existing evidence suggests a clinically relevant link between anemia -particularly IDA - and numerous sleep disorders, with RLS being the most typical and iron-responsive symptom. Iron repletion is a viable mechanism-based treatment for IDA-related sleep disorders.
The foramen rotundum (FR) is a critical skull base aperture transmitting the maxillary division of the trigeminal nerve. Its anatomical variations have significant implications for diagnosis and surgical approaches to skull base lesions. However, population-specific morphometric data for the Indian population remain limited. This study aims to evaluate the morphometric characteristics and anatomical features of the FR in Indian adults using both dry skulls and computed tomography (CT) scans, with emphasis on establishing surgical landmarks for safe skull base surgery. Thirty dry adult human skulls and thirty high-resolution CT scans of adult patients (≥18 years) without skull pathology were examined. Morphometric measurements of the FR, including breadth, height and distance from the anterior clinoid process, were recorded using digital Vernier calipers (dry skulls) and specialized CT analysis software. Statistical comparison between left and right sides was performed using paired t-tests (p≤0.05). The FR was bilaterally present in all specimens with predominantly round shape and regular margins. No accessory foramina, septations, or confluence were observed. In dry skulls, mean breadth and height measured 3.82±0.99 mm and 3.59±0.65 mm (left) and 3.82±0.91 mm and 3.54±0.77 mm (right), respectively. Corresponding CT scan measurements were 2.94±0.53 mm and 2.54±0.44 mm (left) and 2.85±0.45 mm and 2.40±0.44 mm (right). No statistically significant asymmetry was observed between sides. The mean distance from the anterior clinoid process to FR was 10.50±1.19 mm (dry skulls) and 14.06±1.86 mm (CT scans), with no significant lateralization. The present study establishes population-specific morphometric data for FR in Indian adults and validates the anterior clinoid process as a reliable surgical landmark. These findings provide essential reference points for endoscopic and lateral skull base approaches, enhancing diagnostic accuracy and surgical safety while highlighting the need for population-tailored anatomical references in clinical practice.
COVID-19 severity is influenced by age, sex and chronic comorbidities; therefore, unadjusted comparisons may overestimate the independent effect of comorbidity. This revised analysis aimed to compare the clinical profile and disease severity of hospitalized COVID-19 patients without comorbidity, with a single comorbidity and with multiple comorbidities, and to determine whether comorbidity status remained associated with severe disease after adjustment for age and sex. A retrospective record-based cross-sectional study was conducted among 255 adult RT-PCR/RAT-confirmed COVID-19 patients admitted to a tertiary care hospital in Ratlam, Madhya Pradesh, India, from January to March 2021. Patients were categorized as non-comorbid (n=127), single-comorbidity (n=78) and multiple-comorbidity (n=50). Descriptive statistics, chi-square testing, independent t-test and multivariable binary logistic regression were applied. The mean age was higher in comorbid than non-comorbid patients (62.4 ± 12.1 vs 46.2 ± 15.9 years; p<0.001), whereas sex distribution showed no statistically significant difference (p=0.069). Fever (65.49%), cough (53.72%) and dyspnea (33.72%) were the predominant symptoms. Hypertension (71.87%), diabetes mellitus (34.37%) and cardiac disease (12.50%) were the leading comorbidities. Severe disease occurred in 10.23% of non-comorbid patients, 24.36% of single-comorbidity patients and 42.00% of patients with multiple comorbidities (p<0.001). In adjusted analysis, age ≥60 years [adjusted odds ratio (OR) 3.28, 95% confidence interval (CI) 1.62-6.64; p=0.001], male sex (adjusted OR 1.41, 95% CI 0.70-2.86; p=0.338), single comorbidity (adjusted OR 2.05, 95% CI 0.89-4.72; p=0.092) and multiple comorbidities (adjusted OR 3.86, 95% CI 1.56-9.55; p=0.004) were evaluated as predictors of severe disease. Comorbidity burden showed a graded association with COVID-19 severity, particularly among patients with multiple chronic conditions. However, interpretation should account for the confounding effect of age and the limitations of retrospective single-centre data.
Medical students often lead sedentary lifestyles due to prolonged academic commitments, which may negatively affect balance and overall physical well-being. Incorporating short bouts of physical activity into daily routines may help counteract these effects. To investigate the efficacy of integrating short periods of stretching and physical activity into daily routines on balance and physical well-being among medical students. A total of 60 healthy medical students aged 18-21 years, without neuromuscular abnormalities, were randomly assigned into two equal groups, including the study group (n=30) and the control group (n=30), using simple random sampling. Members of the control group continued their routine activities without intervention, while those of the study group performed supervised stretching exercises along with their regular activities. Balance was assessed both before and after the intervention using the single leg balance test (SLBT) and the Berg balance scale (BBS). The study group demonstrated significant improvements in balance following the intervention. Post-test scores showed marked enhancement in eyes-open SLBT (p=0.0025, Z=-3.019, Cohen's d=0.874), eyes-closed SLBT (p=0.0007, Z=-3.372, Cohen's d=1.175) and BBS (p < 0.0001, Z=-6.86, Cohen's d=3.998), indicating moderate to large effect sizes. Incorporating short periods of stretching and physical activity into daily routines significantly improves balance and physical well-being among medical students.
The conventional management modality of refractive amblyopia is patching of the normal eye, which has high recurrence rates. Modern technological advancements have the potential to offer comprehensive visual rehabilitation and improvement in binocular single vision. To compare the clinical efficacy of three novel interventions - Phakic intraocular lens (IOL), Occlu-tab and Orthoptek Magnocellular Stimulator - in managing refractive amblyopia in adolescents and young adults. Young adults with refractive amblyopia who did not respond to occlusion therapy were randomized into three groups: Occlu-tab, Orthoptek and Phakic IOL. Pre- and post-treatment best-corrected visual acuity (BCVA), contrast sensitivity and stereoacuity were assessed. All three modalities produced significant within-group improvements in BCVA, contrast sensitivity and stereoacuity (p < 0.001). Best-corrected visual acuity improved comparably across the three groups, including Orthoptek (mean gain 0.44), Occlu-tab (0.34) and Phakic IOL (0.29 logMAR). There was no statistically significant difference between groups (p = 0.136). Contrast sensitivity gains were higher for Occlu-tab (+0.78) and Orthoptek (+0.78) than for Phakic IOL (+0.59), with a significant between-group difference (p = 0.003). Stereoacuity has markedly improved with Occlu-tab (715.62 sec arc) and Orthoptek (713.54 sec arc) versus less improvement with a Phakic IOL (312.50 sec arc), with the between-group difference being highly significant (p < 0.001). In terms of final binocular functional success rates, Orthoptek and Occlu-tab therapies were superior as compared to Phakic IOLs. A combination of amblyopia therapies should be the approach in the near future.
Nose- and sinus-related neuralgia syndromes (NSNS) constitute a constellation of clinical entities characterized by persistent pain in the distribution of nerves from the nasal cavity and paranasal sinuses. Various characterizations and management approaches have been reported in the literature, yet no universally accepted definition exists. The aim of this study is to provide a narrative synthesis of relevant studies and to propose a structured algorithm for the diagnosis and management of this intriguing clinical entity. A narrative review informed by a structured database search was conducted using Medline (via PubMed), Scopus and manual searching, with no restrictions on publication date. Since Sluder's first description in 1908, a number of related syndromes have been reported in the literature, each with partially overlapping clinical features and diagnostic criteria, including anterior ethmoidal nerve syndrome, anterior ethmoidal neuralgia, sphenopalatine neuralgia, syndrome of the olfactory fissure, nasociliary neuralgia (Charlin's syndrome), collectively reflecting the complex and ambiguous nature of these disorders. While the anterior ethmoidal nerve is central to the syndrome, other nerves innervating the lateral nasal wall and nasal pyramid skin are also implicated in the associated headache. Complex pathophysiological mechanisms contribute to the chronic pain. Clinically, the syndrome is characterized by the absence of a specific sinonasal disease; pain may vary in localization, be uni- or bilateral, and can be associated with mucosal engorgement, intranasal contact points, or a history of facial trauma. A thorough history, clinical examination, nasal endoscopy, imaging of the nasal cavity and paranasal sinuses, recognition of the frequent association with endonasal contact points and the topical anesthetic test remain fundamental to the diagnosis of NSNS. Management options include conservative and surgical approaches. The existing literature on NSNS consists exclusively of small, uncontrolled case series and expert opinion spanning over a century, with no randomized controlled trials or prospective comparative studies, reflecting a persistent evidence gap that limits definitive conclusions about diagnosis and treatment. In this review, a practice-oriented diagnostic and management algorithm is proposed. Prospective controlled studies are needed to validate and refine these recommendations.
Cutaneous melanoma (CMM) is an aggressive malignancy whose incidence continues to rise worldwide. Ultraviolet (UV) radiation from natural and artificial sources is a major environmental risk factor and is classified as a Group 1 carcinogen by the International Agency for Research on Cancer. The present study aimed to evaluate the association between sun exposure patterns and the clinicopathological characteristics of patients with cutaneous melanoma, focusing on tumor thickness and markers of tumor aggressiveness. This retrospective cohort study included 115 patients with histologically confirmed primary cutaneous melanoma treated in our Plastic Surgery Department between January 2018 and December 2022. Demographic, clinical and histopathological data were collected from medical records and Breslow thickness was categorized as thin (≤2 mm) or thick (>2 mm). Statistical analysis included chi-square and Mann-Whitney U tests, followed by multivariate logistic regression to identify predictors of increased tumor thickness. A p-value < 0.05 was considered statistically significant. Statistically significant associations were identified between several clinicopathological variables and melanoma characteristics. Sun exposure pattern was significantly associated with tumor anatomical location [χ²(6) = 85.11, p < 0.001], with chronic exposure predominantly linked to melanomas of the posterior trunk, while intermittent exposure was more frequently observed in melanomas of the lower limbs. Patients with thick melanoma were significantly older than those with thin tumors (p = 0.032). Melanoma thickness was also significantly associated with histological subtype (p = 0.002), ulceration (p < 0.001), and mitotic activity (p = 0.002), with nodular melanoma, ulcerated tumors, and lesions with increased mitotic activity more frequently presenting greater Breslow thickness. Metastatic disease occurred more often in patients with thick melanomas (p = 0.046). In multivariate analysis, mitotic activity remained an independent predictor of thick melanoma [OR = 1.75, p < 0.001], while ulceration showed borderline significance (odds ratio [OR) = 4.14, p = 0.050]. Overall, sun exposure pattern was associated with melanoma location but not with markers of tumor aggressiveness. Sun exposure pattern was associated with melanoma anatomical location but not with tumor aggressiveness. Increased mitotic activity was the strongest independent predictor of thick melanoma, while ulceration showed borderline significance. These findings suggest that intrinsic tumor characteristics play a greater role in melanoma progression than sun exposure patterns.
Mucormycosis is an opportunistic infection caused by fungi of the order Mucorales and Candida is a yeast which is the most common cause of fungal infections in humans. The most commonly known risk factor for these fungal infections is uncontrolled diabetes mellitus (DM), followed by other causes of immunosuppression like neutropenia and corticosteroid therapy. In atypical clinical presentations, all differential diagnosis should be considered, and followed by histopathological and microbiological examination for diagnosis of fungal infections like mucormycosis and candidiasis in uncommon locations. Early diagnosis and combined medical and surgical treatment, along with resolution of the associated risk factors can lead to effective results and good prognosis.
Rhinitis is a heterogeneous condition frequently associated with variable allergic sensitization patterns, comorbid atopic disease and ear, nose and throat (ENT)-associated upper airway findings. Real-life cohorts may provide clinically useful information regarding the combined allergological and otorhinolaryngological assessment of patients presenting with rhinitis-related symptoms. This study aimed to describe the clinical, allergological, comorbidity-related, treatment-related and ENT-associated characteristics of a small real-life cohort of pediatric and adult patients presenting with rhinitis-related symptoms. A retrospective descriptive pilot study, including the first 30 consecutive eligible patients evaluated between January 2024 and April 2026 in a combined private ENT and allergology practice in Ploiești, Romania, was conducted. Clinical data, allergological profile, associated comorbidities, total nasal symptom score (TNSS), ENT findings, sleep-related clinical variables and treatment patterns were analyzed descriptively. Participants' median age was 37.5 years, with a range from five to 71 years. The cohort included 11 pediatric patients and 19 adults. Allergic rhinitis was identified in 22 patients, while eight subjects were classified as having non-allergic rhinitis. Among allergic patients, monosensitization was recorded in 10 patients and polysensitization in 12 patients. Asthma was the most frequent comorbidity, being identified in 15 patients. TNSS values were available for 26 patients; mild symptoms predominated in 19 patients, while moderate and severe symptoms were recorded in five and two patients, respectively. Inferior turbinate hypertrophy was the most frequent ENT finding (19 patients), followed by septal deviation (nine patients), adenoid hypertrophy (seven patients) and nasal polyposis (two patients). Oral antihistamines were recorded in 24 patients, intranasal corticosteroid monotherapy in 13 patients, intranasal combination therapy in 12 patients, allergen-specific immunotherapy in six patients and biological therapy with dupilumab in one patient. This small real-life descriptive cohort highlights the heterogeneity of rhinitis-related presentations in combined ENT and allergology practice. Patients showed variable allergic sensitization patterns, frequent asthma, different degrees of symptom burden and common ENT-associated findings. These observations support individualized evaluation and multidisciplinary collaboration in patients with persistent or clinically complex rhinitis symptoms.
Lymphocele formation is a common complication after pelvic lymphadenectomy and is usually asymptomatic. In rare cases, secondary infection may occur and lead to severe complications. We report the case of a 64-year-old woman who developed an infected pelvic lymphocele complicated by perforation of the sigmoid colon following pelvic lymphadenectomy and radiotherapy for endometrial cancer recurrence. The patient required emergency surgery, followed by targeted antimicrobial and antifungal therapy, which resulted in favorable clinical outcomes. This case highlights a rare but life-threatening complication of pelvic lymphocele, emphasizing the importance of early recognition and timely surgical management.
Human fetal brain development involves complex processes of cellular proliferation, neuronal migration and differentiation. Although several studies have independently evaluated cytology or immunohistochemistry in fetal brain development, integrated analyses using both approaches remain limited. This descriptive observational study was conducted on brain tissues obtained from nine aborted human fetuses of different gestational ages distributed across the first, second and third trimesters. Fetuses with visible congenital anomalies, autolysis, or damaged brain tissue were excluded. Histological evaluation was performed using Masson's trichrome and reticulin stains. Immunohistochemical analysis was carried out using Ki-67, c-myc and Ber-H2 (CD30) antibodies. Immunostaining intensity was graded semi-quantitatively on a scale from 0 to 4+ according to the percentage of immunoreactive cells. Developing neuronal cells and pyramidal neurons were observed predominantly in later gestational stages, along with scattered oligodendrocytes and reticular fibers. Immunopositive cells were mainly localized in the white matter and ventricular regions, whereas comparatively lower staining was observed in the granular layers. Progressive increases in immunoreactivity were observed with advancing gestational age, particularly in the ventricular zone, cortical plate and white matter. Among the markers studied, Ki-67 demonstrated the highest immunopositivity, followed by c-myc and Ber-H2 (CD30). The present study demonstrates gestation-related variations in the immunohistochemical expression of Ki-67, c-myc and Ber-H2 (CD30) in the developing human fetal brain. These findings contribute baseline developmental data that may assist future studies investigating fetal neurodevelopment and neuropathological conditions.
Type 2 diabetes mellitus (T2DM) is a rapidly growing public health challenge in India, driven by urbanization, lifestyle transitions and increasing obesity. Early identification of associated cardiometabolic risk factors is essential to reduce complications and improve disease outcomes. To assess the prevalence of diabetes and prediabetes and to evaluate associated clinical and socioeconomic risk factors among patients attending a tertiary care center in North India. This cross-sectional study included 696 participants who were evaluated for glycemic status, anthropometric measurements, blood pressure and comorbidities. Diabetes and prediabetes were classified according to standard guidelines. Obesity was defined using Asian-specific body mass index (BMI) cut-offs and hypertension was categorized based on established criteria. Sociodemographic and clinical data were collected using structured questionnaires. Statistical analysis was performed using appropriate comparative tests, with p<0.05 being considered statistically significant. Among the study population, 89.08% of subjects had diabetes and 10.92% prediabetes. Overweight and obesity were observed in 31.88% and 19.34% of participants, respectively. Hypertension was highly prevalent, with 34.52% of subjects being classified as Stage 2 and 17.96% Stage 1 hypertension. A positive family history was reported in 23.85% of cases. Most patients had a disease duration of less than five years (56.32%). The clustering of obesity, hypertension and diabetes indicated a significant cardiometabolic overlap. The study highlights a substantial burden of diabetes and its associated modifiable risk factors in a North Indian population. Strengthening early detection strategies, lifestyle modification programs and integrated management approaches is essential to reduce long-term complications and improve public health outcomes.
Accurate assessment of left ventricular ejection fraction (LVEF) is fundamental to the diagnosis, risk stratification and management of cardiovascular diseases. Cardiac magnetic resonance imaging (CMR) is the established reference standard, while echocardiography and global longitudinal strain (GLS) provide widely accessible alternatives. This study compared LVEF by CMR, two-dimensional echocardiography (2D Echo), three-dimensional echocardiography (3D Echo) and GLS in patients with cardiovascular diseases at a Northeast Indian tertiary care centre. A hospital-based prospective observational comparative study enrolled 50 patients with confirmed cardiovascular pathology at Assam Medical College and Hospital (AMCH), Dibrugarh. Cardiac magnetic resonance imaging was performed on a Siemens Magnetom Avanto 1.5 T scanner; echocardiography employed the Philips Affiniti CVx system. Agreement was assessed by Bland-Altman analysis and intraclass correlation coefficient (ICC). The mean CMR-LVEF was 48.5 ± 12.3%. 2D Echo showed a mean positive bias of +2.7 percentage points (95% limits of agreement [LoA]: -8.5% to +13.9%; ICC 0.89) and 3D Echo showed superior agreement (bias +1.3%; LoA -6.2% to +8.8%; ICC 0.93). Upward reclassification by 2D Echo occurred in 26% of patients. Global longitudinal strain strongly correlated with CMR-LVEF (r = -0.87, p < 0.001) and identified subclinical dysfunction in 35% of patients with preserved LVEF (≥50%). Cardiac magnetic resonance remains the reference standard for LVEF quantification. 3D Echo shows significantly superior agreement with CMR versus 2D Echo. Global longitudinal strain provides incremental diagnostic value beyond LVEF. A tiered multimodality imaging strategy with selective CMR confirmation at clinical decision boundaries is recommended.
Vitamin D deficiency is linked to rickets in children, precocious puberty in adolescents, polycystic ovarian syndrome in adults and osteoporosis in older adults. Its requirements for females differ according to the stages of life. This study aims to estimate the proportion of vitamin D deficiency in female patients at different stages of life. This cross-sectional retrospective study was done on female patients undergoing vitamin D estimation from January to December 2024 in All India Institute of Medical Sciences, Raebareli, India.. Vitamin D estimation in serum was conducted on VITROS 5600 Immunodiagnostic Systems by chemiluminescence immunoassay technique. Serum levels of ≥30 ng/mL, 20-30 ng/mL and < 20 ng/mL were considered normal, insufficient and deficient, respectively. Data was collected in a Microsoft Excel spreadsheet and analysed by IBM SPSSv25. Vitamin D estimation was done on 8 403 female patients. Deficient, insufficient and normal vitamin D levels were seen in 33.3%, 31.0% and 35.7% of subjects, respectively. Analysis according to the life stages highlighted that adolescents (13-18 years) had the highest (46.8%) deficiency, followed by young adults (19-24 years) (40.0%). Mean vitamin D levels were the lowest (24.2±15.9 ng/dL) in adolescents (13-18 years) and the highest (40.9±27.6 ng/dL) in newborns and babies (0-1.9 years) (F=22.8, p=0.00). Significant seasonal differences in vitamin D levels were observed, with the lowest (25.9±18.8 ng/dL) being seen in February and the highest (31.8±17.1 ng/dL) in August (F=7.1, p=0.00). Across the stages of life in female patients, adolescents (13-18.9 years) had the highest burden of vitamin D deficiency. Incorporating vitamin D supplementation under the national health programme for adolescent females will be beneficial.
Bruxism is an oral habit that sums symptoms like tooth clenching, grinding and jaw contractions. This study aimed to evaluate self-assessment bruxism among dental students. A questionnaire assessing the perception of bruxism symptoms was administered to a cohort of students (n=301) from "Carol Davila" University of Medicine and Pharmacy, Bucharest, Romania. Data regarding demographics, lifestyle and current symptoms were collected. Statistically significant associations between sedentary behavior (lack of sport participation) and bruxism symptoms were found. Participants who did not practice a sport were more likely to report sleep grinding (36.1% vs. 24.5%, p=0.041), increased tooth wear (21.5% vs. 10.9%, p=0.027) and clenching upon waking (31.4% vs. 20.9%, p=0.049). Conversely, those who reported never clenching during stressful situations were more likely to be physically active (43.6% vs. 25.1%, p=0.009). Similarly, absence of clenching during tense moments was associated with sports participation (47.3% vs. 27.7%, p=0.005). Psychosocial factors and lifestyle significantly impact the presence of bruxism symptoms. The results of the present study suggest that physical activity may reduce the risk of bruxism-associated symptoms. However, correlating perceived symptoms with objective clinical assessment remains necessary.
Mycoplasma pneumoniae (MP) is a major cause of community-acquired respiratory infections, especially in school-aged children and young adults, with cyclical outbreaks occurring every few years. This study analyzed a cohort of pediatric patients treated in a tertiary hospital in Bucharest and compared the findings with data reported in the literature. Elevated anti-MP antibody titers (IgG, IgA and IgM) were associated with increased leukocytosis, neutrophilia, complications and longer hospitalization. Fever, lobar involvement and complications were also linked to prolonged hospital stay. Our findings are consistent with international data and reflect the typical epidemiological profile of MP infection in children. These results contribute to the characterization of MP infection in the post-COVID era and support the need for prospective studies to validate the identified prognostic markers.
Laparoscopic cholecystectomy is among the most frequently performed surgical procedures worldwide; however, it carries a persistent risk of iatrogenic bile duct injury, particularly in the presence of anatomical variations. Misinterpretation of biliary anatomy remains a leading cause of serious complications, underscoring the importance of recognizing rare variants and adopting safe surgical strategies. We report the case of a 78-year-old patient undergoing elective laparoscopic cholecystectomy for recurrent cholecystitis and cholangitis. Given the history of repeated inflammatory episodes, dense adhesions and intraoperative technical difficulties were anticipated. Intraoperatively, dense adhesions and a contracted gallbladder were encountered. Indocyanine green fluorescence imaging revealed uncertain anatomical landmarks, demonstrating a rare parallel configuration of the cystic duct and common hepatic duct. Due to unsafe conditions, conversion to open surgery was performed, allowing safe ligation of the cystic duct. The postoperative course was uneventful. This case highlights the critical role of anatomical awareness, intraoperative vigilance and timely adoption of bailout strategies to ensure a safe cholecystectomy and prevent biliary injuries.
Hemoglobin comprises numerous variants, with fast-moving hemoglobin categorized as rare occurrences. These variants are primarily caused by the substitution of a negatively charged amino acid residue in the α, β, or γ globin chains. Cation exchange high-performance liquid chromatography (CE-HPLC) is an automated and accurate diagnostic tool for hemoglobinopathies. The α-globin variant Hb J Meerut is infrequently observed, having been reported in various populations globally, yet it is notably rare in Gujarat, India. We hereby report two cases of Hb J Meerut hemoglobinopathy in Saurashtra-Kutch region of Gujarat, India. Preventive strategies including pre-marital and antenatal screening, coupled with public awareness and genetic counseling, are vital to mitigate the silent burden of hemoglobinopathies.
We report a case series of seven patients aged 24 to 78 years who presented with unilateral elevation of the diaphragm secondary to diverse underlying mechanisms. The diagnoses included sarcoidosis-related pulmonary inflammation, gallbladder adenomyomatosis with sepsis and metabolic derangement, pulmonary tuberculosis with Chilaiditi's syndrome, acute pulmonary embolism with diaphragmatic eventration, superior vena cava syndrome due to non-small cell lung carcinoma, cryptogenic organizing pneumonia with an incidental thymic cyst and pyogenic liver abscess. This series emphasizes that unilateral diaphragmatic elevation should not be attributed only to phrenic nerve injury or primary diaphragmatic paralysis; pulmonary, abdominal, vascular, mediastinal and inflammatory causes should also be systematically evaluated. Early identification and treatment of the primary disorder resulted in clinical improvement and radiological normalization in most reversible cases.
Introduction: Motor vehicle collisions, violence between individuals, falls, sports-related accidents and firearm injuries are frequent causes of maxillofacial trauma, which is a significant public health concern. Alcohol intoxication and a lack of use of protective gear are two factors that are known to raise the risk and complexity of these injuries. Despite its clinical and societal impact, region-specific data on the distribution of maxillofacial trauma by anatomical site and etiology in Manipur, India, remain limited. This observational investigation was conducted to determine the patterns of maxillofacial fractures in terms of anatomical location and causative factors, identify the prevalence of protective equipment usage and explore the relationship between alcohol consumption and the etiology, anatomical site and severity of facial injuries. Methods: A prospective observational study was conducted over a two-month period at tertiary care hospitals in Manipur, enrolling 44 patients with radiographically confirmed maxillofacial trauma. Data on demographic characteristics, clinical presentation and imaging findings were systematically collected. The severity of facial injuries was assessed using the AIS-90 facial injury scale. Association between alcohol intoxication and various injury parameters were analyzed using the Chi-square test (p value < 0.05). Results: Males constituted the predominant proportion of patients (84.1%), with a mean age of 31.1 years. Fractures of the mandible were most common (50%), followed by dentoalveolar (15.9%) and midfacial fractures (11.4%). Road traffic accidents (RTAs) were the predominant cause (61.4%), followed by assault (13.6%) and accidental falls (9.1%). Only 2.3% of patients reported using protective gear at the time of injury. Alcohol intoxication was observed in 40.9% of cases and was significantly associated with RTAs (p value <0.05), fracture site (p value < 0.005) and severity (p value < 0.05). Conclusion: Motor vehicle collisions were identified as the leading cause of maxillofacial injuries, with alcohol intoxication and inadequate use of protective equipment markedly increasing both the risk and severity of trauma. Enforcement of helmet and seatbelt regulations, public awareness on alcohol-related risks and promotion of protective gear use are essential to reduce maxillofacial injuries in the region.