Thickness of the ligamentum flavum: correlation with age, sex, side, spinal level and degenerative disc disease

Background: Few researchers have studied thickness at different spinal levels and compared with age, sex, side, spinal level and relationship with degenerative disc disease. However, there is no literature pertaining to the study of LF thickness correlation with all these five parameters in single study. Here, we determined the correlation of dorsal and lumbar spine LF thickness with age, sex, side asymmetry, at different spinal levels and relation with degenerative disc disease (DDD) using magnetic resonance imaging (MRI). Methods: LF thickness was measured retrospectively at all dorsal and lumbar spinal levels (T1 to S1 level) on both sides in MRI scans of 200 individuals attending Shree Narayana Hospital, Raipur, Chhattisgarh from 1st July 2023 to 30th June 2024. On axial T2-weighted MRI at the mid-disc level, LF thickness was measured perpendicular to the lamina border, either at half the length of LF or at maximum thickness, whichever was greater. Results: All results were collected in tabular form. All individuals were divided into three age groups- 21to 40 years,41 to 60 years, 61 to 80 years. LF thickness increase significantly with increasing age, but there was no side or sex dominance. LF thickening has a predominant tendency to occur specifically at the T10-T11 and L4-L5 levels and was significantly more in those having associated degenerative disc disease. Conclusions: LF thickness does not appear to have any side or sex dominance but increase significantly with increasing age. Also, LF thickness have significant correlation with spinal levels. LF thickness was significantly higher in those having associated degenerative disc disease

An elusive diagnosis: a case of Plummer-Vinson syndrome

Plummer-Vinson syndrome (PVS), also known as sideropenic dysphagia or Paterson-Brown-Kelly syndrome, is a rare medical disorder characterised by triad of iron deficiency anaemia, dysphagia, and oesophageal webs, more often seen in middle-aged females. We present a case of a 37-year-old female who came with complaints of difficulty in swallowing food, fatigue, and generalised body weakness for the past 6 months. Her hematological workup revealed microcytic hypochromic anaemia and barium studies showed smooth concentric narrowing of the cervical oesophagus at the level of the C5-C6 vertebrae (post-cricoid oesophageal web). Hence a diagnosis of Plummer -Vinson syndrome was made. Endoscopic dilatation was done to treat her dysphagia. Her iron deficiency anaemia was corrected with 1-unit prbc transfusion and intravenous iron sucrose supplementation. She was encouraged to eat an iron-rich diet. When she came for a follow-up after six weeks of oral iron supplementation, her condition was satisfactory, and dysphagia had improved

A cross-sectional study to evaluate the safety and efficacy of post-placental and intra-cesarean insertion of intrauterine contraceptive device

Background: India’s growing population necessitates effective postpartum contraceptive methods to reduce unintended pregnancies and to improve reproductive health outcomes. Postpartum intrauterine contraceptive devices (PPIUCDs) offer a reversible, long-term solution, but insertion timing- post-placental or intra-cesarean may affect their safety and efficacy. Objective was to compare the safety and efficacy of post-placental versus intra-cesarean insertion of IUCDs among postpartum women in a tertiary care hospital in Assam, India. Methods: This prospective observational study enrolled 210 postpartum women from June 2023 to May 2024 at the Fakhruddin Ali Ahmed Medical College and Hospital, Assam. Eligible participants underwent either post-placental or intra-caesarean insertion of CuT 380A IUCDs. Data on demographics, complications, and continuation status were collected at six months post-insertion. Statistical analysis was done using appropriate statistical tests. Results: Participants’ mean age was 28±4.1 years; 79.5% were primipara. Continuation rates of PPIUCD was 77.6%, with 26.4% and 19.3% discontinuing in the post-placental and intra-caesarean groups, respectively. Expulsion rates were higher in the post-placental group (15.4%) compared to intra-caesarean (1.7%) (p<0.001). Complications included excessive bleeding, pain, missing thread and expulsion. Factors such as age, parity, and insertion type influenced continuation, with multiparous women and intra-caesarean insertions demonstrating higher retention rates. Conclusions: Intra-caesarean IUCD insertion is associated with lower expulsion rates and comparable continuation rates compared to post-placental insertion. Addressing social barriers and managing complications can further enhance PPIUCD utilization. These findings can help to design strategies for improving family planning interventions in similar settings

Dr. Yellapragada Subba Rao: an Indo-American trailblazer in the field of medicine

Dr. Yellapragada Subba Rao (1895-1948) was a pioneering biochemist whose contributions have left a profound impact on modern medicine. Born into a Telugu family in India, SubbaRao's educational journey took him from Madras Medical College to prestigious institutions like Harvard Medical School and the School of Tropical Medicine, London. Despite the interruption of his medical education due to his involvement in the Indian independence movement, SubbaRao made ground-breaking advancements in biochemistry. Notably, his collaboration with Cyrus Fiske led to the development of the Fiske-Subbarow Method for phosphorus estimation and elucidated the role of phosphocreatine and ATP in muscle function. His research on vitamin B12 significantly advanced the understanding of anaemia treatment, while his work on folic acid contributed to its synthesis and therapeutic applications. SubbaRao’s contributions extended to oncology and infectious diseases; his work was instrumental in developing methotrexate, an early chemotherapy drug and discovering chlortetracycline, the world’s first tetracycline antibiotic. His innovative biochemical assays and research on metabolic pathways have facilitated the development of various treatments and antibiotics, fundamentally shaping the field of drug discovery and clinical practice. Despite his passing at a young age, SubbaRao's legacy endures through his significant scientific achievements and the recognition of his contributions, including tributes such as a commemorative postal stamp and the naming of species and institutions in his honour. His work remains influential in on-going research and medical applications, underscoring his role as a key figure in the advancement of biochemistry and medicine

A retrospective drug utilization study in chemotherapy-induced nausea and vomiting

Background: Chemotherapy-induced nausea and vomiting (CINV) significantly impacts patients' quality of life. Despite advancements in therapy, optimal management of CINV remains crucial. This study evaluates drug utilization patterns in CINV management in patients attending the government cancer hospital, Chhatrapati Sambhajinagar (Maharashtra). Objective were to evaluate the drug utilization patterns in CINV management amongst cancer patients. Methods: Retrospective, cross-sectional observational study in 242 cancer patients attending the outpatient department in a government cancer hospital, Chhatrapati Sambhajinagar. The prescriptions were taken from the record section after the necessary approval of IEC and permissions. Prescriptions were evaluated as per WHO drug prescribing indicators. Results: The 484 drugs were prescribed for CINV in 242 patients. Most patients were aged between 51-60 years (31.82%), followed by 41-50 years (26.86%). All drugs are prescribed under generic names. Three classes of drugs were identified as monotherapy or combination therapy. 5-HT3 receptor antagonists and corticosteroids were the two most frequently used classes, followed by NK1 receptor antagonists. In prescribing patterns, dual combination regimens of 5-HT3 receptor antagonists and corticosteroids were the most common (99.17%), followed by triple combination and monotherapy (0.41% each). Out of the total, 483 (99.79%) drugs were given by parenteral route and 1 (0.21%) by oral route. Conclusions: Following standard protocols for CINV was noted. The use of 5-HT3 receptor antagonists (Granisetron) and corticosteroids (dexamethasone) in combination was common, suggesting a pattern of adherence to guidelines and improving patient care

Uterine carcinosarcomas case series of rare uterine malignancy

Primary malignant mixed Müllerian tumor (MMMT) of the ovary is a rare and highly aggressive neoplasm predominantly affecting postmenopausal women. MMMT is a biphasic tumor comprising both epithelial and mesenchymal components and is associated with significantly higher mortality compared to epithelial ovarian neoplasms. Patients typically present with symptoms such as vaginal bleeding, abdominal pain, and a palpable mass. Surgery remains the primary treatment modality, while adjuvant therapies, including chemotherapy and radiotherapy, play a crucial role in improving locoregional control and managing distant metastasis. Due to the rarity of these tumors, there is limited literature on their optimal therapeutic management. This series aims to analyse the clinical presentations and treatment outcomes of patients diagnosed with this uncommon uterine cancer treated at our hospital

Knowledge, attitude and practice regarding human papillomavirus vaccination among medical students

Background: Cervical cancer is a leading cause of cancer-related deaths among women, especially in developing countries like India. Human papillomavirus (HPV) types 16 and 18 are primary causative agents, and the HPV vaccine is a key preventive tool. However, uptake remains low due to limited awareness, safety concerns, and cultural misconceptions. This study aimed to evaluate knowledge, attitudes, and practices (KAP) regarding HPV vaccination among medical students and to identify barriers and facilitators to vaccine uptake. Methods: A cross-sectional study was carried out at a tertiary care teaching hospital in Amritsar India. Undergraduate students aged 18-22 years, from 1st, 2nd, 3rd and 4th year professional MBBS students were included in the study. Results: Out of 300 participants, 229 (76.33%) were aware of the HPV vaccine, while only 21 (7%) had received it. Common barriers included limited access, concerns over safety and efficacy, and cost. Demographic factors like age, gender, maternal education, and family history of malignancy showed no significant association with knowledge levels. A majority expressed willingness to get vaccinated in the future. Conclusions: Medical students in India demonstrate moderate knowledge of HPV vaccination. Improving education on vaccine safety and efficacy, incorporating it into the curriculum, increasing awareness programs, reducing costs, and introducing supportive government policies may enhance vaccine acceptance

Hypothyroidism in pregnancy current guidelines, prevalence, and implications for maternal and fetal health

Hypothyroidism during pregnancy is a common endocrine disorder that can drastically impact the mother and fetus in the process of development. The two types of hypothyroidism in pregnancy are distinguished as overt and subclinical, with the latter being more prevalent. Subclinical hypothyroidism (SCH) is commonly caused by autoimmune thyroid disorders and iodine deficiency. In iodine-sufficient areas, hypothyroidism is caused by Hashimoto’s thyroiditis, whereas, in iodine-deficient areas, hypothyroidism is primarily caused by iodine deficiency. Diagnosing hypothyroidism during pregnancy is often challenging because its symptoms often mimic those of normal pregnancy. During pregnancy, thyroid function undergoes significant alterations. The disruption of the normal functioning of the hypothalamic-pituitary-thyroid axis causes fluctuations in both thyroid stimulating hormone (TSH) and thyroxine (T4) levels. Elevated human chorionic gonadotropin (hCG) and estrogen levels trigger the thyroid gland to increase hormone production. If hypothyroidism is not managed properly throughout pregnancy, it could lead to preeclampsia and premature delivery and neurodevelopmental concerns in the baby. It is recommended to consider hypothyroidism screening for women with autoimmune conditions or an existing history of thyroid disease due to their increased risk. The main treatment for pregnant women with hypothyroidism is levothyroxine, whose dosage is regulated to meet the increased demand for thyroid hormones. Continuous monitoring of free T4 levels and TSH is crucial in maintaining hormonal balance. The present review explores the prevalence of hypothyroidism during pregnancy, physiological changes, maternal and fetal complications, and the evidence-based guidelines for the management. Following current recommendations and proper treatment minimizes the risks for the mother and the baby

Outcomes of microsurgical flap techniques in the reconstruction of extensive lesions due to advanced basal cell carcinoma: a systematic review of complications, recurrence, and aesthetic satisfaction

Basal cell carcinoma (BCC) constitutes 70–80% of non-melanoma skin cancers, with an estimated 4.3 million new cases annually in the U.S. Though rarely metastatic, advanced BCC can cause extensive local tissue destruction, particularly in facial regions, necessitating surgical excision followed by complex reconstruction. This study evaluates outcomes of microsurgical flap reconstruction in advanced BCC, with a focus on complications, recurrence, and patient-reported aesthetic satisfaction. A systematic search across six databases until May 2025 identified 263 abstracts, of which 34 full texts were reviewed; nine studies met inclusion criteria. Due to methodological heterogeneity, a narrative synthesis was conducted. Most studies reported low complication rates, with serious issues occurring in fewer than 10% of cases and no significant differences across flap types or age groups. Recurrence rates ranged from 0.22% to 4.4%; notably, 447 lesions treated with narrow margins and frozen section analysis showed a recurrence of only 0.22%. A meta-analysis reported an overall recurrence rate of 2%, with the Muffin technique associated with superior outcomes. Aesthetic results were favorable: OM flaps yielded high satisfaction rates (77.8%, p=0.002) with shorter operative times, and periocular reconstructions demonstrated successful outcomes in 87% of cases, outperforming radiotherapy (69%). However, definitions of "satisfactory" varied across studies. Despite limitations such as inconsistent outcome reporting and short follow-up durations, microsurgical reconstruction in advanced BCC appears safe, effective, and cosmetically satisfactory. OM flaps, in particular, are seen as efficient by both clinicians and patients. Standardized, long-term studies are essential for definitive conclusions

Epidemiology, genotypic diversity and age-specific risk pattern of circulating human papillomavirus in Dhaka City, Bangladesh: a five-year study (2020-2024)

Background: Human papillomavirus (HPV) is among the most prevalent sexually transmitted illnesses globally, particularly with certain high-risk genotypes known as the predominant etiological agents of cervical carcinoma, which remains a considerable public health threat, especially in low- and middle-income countries (LMICs), like Bangladesh. Methods: This study investigated the frequency, characteristics, and distribution of HPV genotypes among women in Dhaka City, Bangladesh, from 2020 to 2024. The HPV genotypes were detected by real-time polymerase chain reaction (PCR) from extracted DNA of cervical swab samples. Results: Among 2049 tested participants, the overall HPV prevalence was 4.01%, with significant temporal variations observed throughout the study period. The highest number of positive cases, 29 (4.71%) out of 587, was recorded in 2024, while 2020 showed the lowest incidence, 1 (2.5%) positive case out of 39 cases. Seasonal analysis revealed higher case numbers during Winter (29%) and Autumn (30%), followed by Summer (26%), with Spring showing the lowest incidence (15%). Age distribution analysis indicated that middle-aged adults (35-50 years) represented the largest group with 37 cases, followed by adults aged 25-34 years (25 cases). The most prevalent genotype combination was HPV 16/31 (55 cases), followed by HPV 18/45 (16 cases). Conclusions: This unique genotype distribution pattern differs from global trends and has important implications for vaccination strategies in Bangladesh. The findings suggest the need for broader-spectrum vaccines and age-specific screening programs, while highlighting the importance of considering seasonal variations in public health interventions