Use of the Mustardé flap in facial reconstruction following surgery for cutaneous squamous cell carcinoma: a case report

Basal cell carcinoma (BCC) is the most common cutaneous malignancy, comprising nearly 80% of non-melanoma skin cancers. Despite its typically slow growth and low metastatic potential, BCC demonstrates a locally aggressive behavior capable of causing substantial tissue destruction if not promptly addressed. Lower eyelid is frequent site of involvement, representing a unique therapeutic challenge due to its intricate anatomical architecture and the critical balance between its protective ocular function and aesthetic significance. Surgical management in this region demands precise oncologic excision combined with meticulous reconstructive planning to preserve eyelid function and facial harmony

A prospective study on correlation of high-resolution computed tomography temporal bone and surgical findings in squamosal chronic otitis media

Background: Chronic otitis media (COM) is a common condition seen in patients attending ENT department. It is caused by persistent inflammation of the middle ear and mastoid cavity and when left untreated, can lead to significant complications, including the development of squamosal chronic otitis media (SCOM). The aim of this study is to assess the role of high-resolution computed tomography (HRCT) temporal bone in preoperative evaluation of squamosal chronic otitis media. Methods: This study is a prospective study involving 50 cases of COM. All the patients underwent pre-operative HRCT followed by surgical exploration of middle ear cleft to compare the HRCT findings with the operative findings, thereby establishing a robust correlation between radiological assessment and surgical observations. Results: The result of the study reveals varying levels of agreement between CT and operative findings across different structures, with generally high concordance rates and statistically significant p values, indicating the reliability of CT in diagnosing these conditions. All findings are statistically significant, emphasizing the consistency between CT and operative findings. The result also highlights that CT scans have high levels of reliability in detecting ossicular erosion, various types of malleus erosion, with good to very good agreement for head of malleus and handle of malleus erosion. Conclusions: The study highlights the potential of HRCT to improve surgical outcomes by enabling more precise and targeted interventions, ultimately leading to better eradication of the disease from the middle ear cleft

A scintillating tale of the early stages of self-directed learning for future doctors in a growing medical college

Background: Self-directed learning (SDL) is a pivotal element in modern medical education, encouraging learners to take ownership of their learning process. In response to the National Medical Commission (NMC)'s mandate, this study aimed to assess the influence of SDL among preclinical and paraclinical students at AMCH (Arunai Medical College and Hospital) Tiruvannamalai, Tamilnadu, India. Methods: Through mixed research methods, we evaluated the awareness of SDL, faculty perceptions, and student learning outcomes. The study involved the implementation of an innovative assessment tool, AMAI (Arunai Metacognitive Assessment Instrument), to track progress in the SDL process and eliminate bias. Results: The study revealed increased student engagement, reflective practices, and improvements in analytical thinking at the metacognitive level. The AMAI assessment tool played a crucial role in ensuring consistency and tracking student development. Conclusions: This research highlights the effectiveness of SDL in medical education, demonstrating its impact on student performance and faculty involvement. The AMAI tool serves as a structured framework for evaluating SDL implementation

The challenges of managing acute myeloid leukemia in pediatric patients: a review of current treatment strategies

Acute myeloid leukemia (AML) in pediatric patients presents with complex pathophysiology but a diverse treatment response and so is a difficult disease to treat. Despite substantial progress in genetic profiling of the diseases and precision medicine as well as targeted therapies, pediatric AML continues to be a significant cause of loss of life to cancer in children. Intensive chemotherapy, hematopoietic stem cell transplantation (HSCT), and FLT3 inhibitor are most of the treatment strategies used so far. However, therapeutic efforts are complicated by the high risk of relapse of certain patient subtypes and disease genetic heterogeneity, as well as continually rising incidence of resistance. Novel insight in the field of immunotherapy such as monoclonal antibodies, CAR-T cell therapy, and conjugation of FLT3 inhibitor in therapy hold promise for improved efficacy and decreased toxicity in the recent past. Nevertheless, conventional therapy of pediatric AML is still not an option for these pediatric AML patients with high risk genetic mutation (TP53), so new paradigms in treatment of pediatric AML are required. Then, the current treatment strategies for high risk pediatric AML are reviewed, the challenges in the management of the disease are discussed, and how emerging treatments may improve survival are discussed. The outcomes of genetic mutations, treatment protocols and reviewed combined advantages of current clinical trials is included and made available as valuable insights in pediatric AML treatment on this paper

Vitamin D deficiency: a cause of clinical concern

In India, the prevalence of vitamin D deficiency ranges from 35% to 99% despite the fact that India is a tropical country with plenty of sunshine. The prevalence of vitamin D deficiency is high in patients with comorbid conditions such as type 2 diabetes mellitus (T2DM) (84.2%), hypertension (82.6%), and hypothyroidism (76.9%). The effects of vitamin D deficiency are not just restricted to the musculoskeletal system. The presence of vitamin D receptors on the pancreatic beta cells, adipose tissues and skeletal muscle cells indicates the function of vitamin D in the glucose metabolism. Recent literature shows that altered vitamin D and calcium homeostasis may play a role in the development of T2DM. This review delves into recommendation shared by group of expert endocrinologists on skeletal and extra skeletal implications of vitamin D deficiency and the ways to manage patients of vitamin D deficiency. Experts shared that as per guidelines vitamin D deficiency be defined as a 25(OH)D below 20 ng/ml, insufficiency as a 25(OH)D of 21–29 ng/ml, and sufficiency as a 25(OH)D of ≥30 ng/ml. The experts opined that vitamin D levels should be maintained between 40-60 ng/ml for extra skeletal benefits. Vitamin D supplementation has demonstrated potential benefits on glycemic control. Thus, vitamin D supplementation can be added as an effective adjunctive intervention in diabetic and prediabetic patients. Recent advances in technology have enabled delivery of vitamin D through nanoparticle-based Vitamin D which ensure higher absorption and better serum vitamin 25(OH) levels. Experts shared that nano-particle based vitamin D3 appears to be better in achieving higher levels of serum 25(OH)D than that observed with other oral dosage formulations of vitamin D3

Neonatal neuroblastoma in a tertiary health facility in Southwest Nigeria: a case report

Neuroblastoma is a pediatric neoplasm diagnosed in infancy and occurs mainly in the abdomen. There is a paucity of data in developing countries, including Nigeria. Therefore, this study aimed to report the first case of neonatal neuroblastoma in a Federal Medical Centre, Owo, Ondo state, Nigeria. We described a 4-hour-old term female neonate with multiple subcutaneous nodules and a right-sided intra-abdominal mass that crosses the midline. Examination reviewed an ill-looking neonate with multiple, painless anterior abdominal wall subcutaneous nodules and abdominal distension with a palpable right-sided abdominal mass. The abdominal MRI revealed a right abdominal mass separated from the normal-shaped kidney and an enlarged liver with multiple nodules. The liver enzymes and urinary vanillylmandelic acid were elevated.  Neonatal neuroblastoma, though rarely reported among Nigerian neonates, should be considered in the differential diagnosis of abdominal mass, and the awareness should be increased among sonographers for early detection

Advances in pediatric anesthesia: safety protocols and emerging practices

Predictive modelling implementation with safety protocols in paediatric anaesthesia has contributed to major improvements in the safety measures and performance quality of child anaesthetic treatment. The review gathers and examines contemporary research between 2017 and 2022 to assess how predictive models can be implemented with safety protocols which improve anesthesia management effectiveness. Healthcare models developed using electronic medical records (EMRs) and real-time monitoring systems and specialized equipment enable medical staff to predict postoperative complications such as respiratory events and thrombotic complications along with blood loss. The advancement of machine learning (ML) technology together with artificial intelligence (AI) supports unique anesthesia treatment plans for risky high-risk pediatric surgeries. Different intervention approaches form the basis of the investigation to enhance care results and minimize medical complications through improved sedation depth monitoring and pain control and airway management practices. The deployment of these models meets continuous resistance to implement across different clinical settings. The study examines contemporary developments in paediatric anaesthesia while stressing the necessity to construct better predictive methods and the AI potential to enhance safety and treatment results for paediatric anaesthesia care

Enteric fever: current issues in effective management and control

Typhoidal salmonella is the causative agent of enteric fever. All are strict human pathogens. It spread through the consumption of contaminated food and water. It presents with high-grade fever, rigors, headache, malaise, some abdominal discomfort, leukopenia, thrombocytopenia, and relative bradycardia/tachycardia. None of them is diagnostic for enteric fever. Antibiotics are the mainstay in the treatment. The management of the disease has become problematic due to the development and spread of MDR genes among the bacterial populations. Efficient laboratory support is required for appropriate antibiotic administration. Among the laboratory tests, the only one to be relied upon for definitive diagnosis is blood or bone marrow culture. It is highly specific, but specificity is low, so a number of false negatives can result. Nucleic acid-based tests are not standardized and are resource-intensive, so they cannot be made available to all patients in all areas. Serological methods also lack standardization, so false positives and negatives cannot be ruled out. Vaccination too does not provide good protection, especially in the adults where it has not been extensively studied. The majority of the patients are treated on clinical suspicion, and antibiotics are administered

Conservative surgical management of large bilateral mandibular odontogenic keratocyst: a case report and literature review

Odontogenic keratocyst (OKC) have a been a controversial topic within the medical, research and taxonomy community. It is because of these controversies this requires our special attention. From a clinician’s view, its varied presentation and high recurrence rate makes it special. One possible explanation for such high recurrence is the presence of anti-apoptotic gene; BCL-2 in high concentration in the epithelial lining of OKCs. Even rarer is its presentation bilaterally, we present one such case of a young male. After facing multiple misdiagnosis and any significant improvement, he was finally diagnosed on the basis of biopsy and underwent serial marsupialization followed by enucleation. We present this case to stress on the fact that conservative surgical management by marsupialization under local anaesthesia itself is enough without the need of costly reconstruction in cases with unilocular cyst involving the mandible bilaterally with review of relevant literature.

Atypical presentation of giant cell arteritis: a case report

A 58-year-old female, known hypertensive and hypothyroid, presented with complaints of diffuse headache, decreased appetite, and easy fatiguability over 2 months. Laboratory tests revealed elevated acute phase reactants (ESR-140 mm/1st hour, CRP-70 mg/l), positive ANA profile with anti-Pm-SCL 100 and AMA-M2 positivity. During subsequent visits, she had a recurrence of headaches along with dyspnea on exertion (DOE) being her predominant symptom limiting her daily activities. A superficial temporal artery doppler was done which showed a positive 'halo sign' and right temporal artery biopsy was compatible with the diagnosis of giant cell arteritis (GCA)