Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) is one of the important causes of morbidity, mortality, and healthcare burden. Electrolyte disturbances and acid–base imbalances are frequent but under-recognized complications that may worsen outcomes in cases of AECOPD.Objective: To understand the prevalence of serum electrolyte abnormalities and arterial blood gas (ABG) parameters in patients admitted with AECOPD.Methods: This prospective observational study enrolled 200 patients with confirmed AECOPD admitted to a tertiary care hospital in Kalaburagi, India, over an 18 month period. The ABG analysis and serum electrolytes (sodium, potassium, magnesium, chloride) measurement were performed at admission. Demographic, clinical, and radiological data were also collected. Data were then analyzed using SSPS 23.0, with a P value of < 0.05 considered statistically significant.Results: Abnormalities related to sodium (91.5%), potassium (90.5%), magnesium (80.5%), and chloride (56%) were common in cases admitted with AECOPD. In 45% cases, the PaO₂ <50 mmHg was seen whereas PaCO₂ >45 mmHg was found in 43%. Acid–base imbalance was seen in 35% cases, with 4.5% showing severe acidosis (pH ≤7.1). Cough (72.5%) and breathlessness (60.5%) were most common symptoms. The majority were elderly males (65%) whereas 57% were smokers. Diabetes was the most common comorbidity (30.5%).Conclusion: Electrolyte abnormalities and ABG derangements are nearly universal in AECOPD and have important prognostic implications. Routine metabolic profiling should be integrated into the acute management of COPD to improve outcomes, particularly in resource-constrained settings.

Background: Treatment options are limited for heavily pre-treated metastatic breast cancer patients, with Eribulin showing promise in improving survival outcomes.Objective: To evaluate Eribulin outcomes in patients with MBC. Metastatic or incurable diseases are observed in 4% to 10% of women despite advances in breast cancer treatment. To address this problem, EMBRACE, an important randomized phase III clinical trial was carried out by comparing eribulin to the treatment selected by physicians for individuals with previously treated locally recurrent or metastatic breast cancer (MBC). The results showed a significant and prolonged increase in median overall survival among patients treated with eribulin, compared to those who received the physician's selected treatment.Case Series: This study presents three patients who showed favorable outcomes after treatment with eribulin, despite multiple lines of previous therapy. Patient 1 was diagnosed with triple-negative breast cancer and initially achieved remission before experiencing a recurrence involving a chest lesion and enlarged lymph nodes. After two cycles of eribulin, the patient showed significant improvement. Patient 2 developed brain and liver metastases following the completion of hormonal therapy, prompting the initiation of eribulin as the next line of treatment. Patient 3 had disease progression despite undergoing multiple lines of hormonal and chemotherapy. Eribulin was administered and patient remained stable.Conclusion: Patients with MBC tend to have substantially favorable outcomes with eribulin chemotherapy even after extensive previous treatment.

Background: Super Refractory Status Epilepticus poses significant management challenges, requiring intensive therapeutic approaches including general anesthesia.Objective: To discuss the management of Super Refractory Status Epilepticus (SRSE) with general anesthesia to control seizures.Case Illustration: A 17-year-old female with tonic-clonic seizures, headache, unclear speech, and a change in behavior, who also appeared to be restless, was presented. She was admitted to the intensive care unit and administered anticonvulsant medication. A brain MRI with contrast showed the impression of meningitis, and cerebrospinal fluid examination showed a positive anti-NMDAR result. First-line therapy involved high-dose steroids and intravenous immunoglobulin for 5 days, followed by second-line therapy with rituximab. Patient received general anesthesia using sevoflurane volatile, dexmedetomidine, continuous rocuronium, propofol, ketamine, and fentanyl due to persistent seizures despite receiving anticonvulsant therapy. Monitoring was conducted for vital signs, seizure activity, and depth of anesthesia using the bispectral index (BIS). Tonic-clonic seizures in patients were successfully managed with general anesthesia. However, facial dyskinesia was still present despite the administration of general anesthesia. Facial dyskinesia worsened upon discontinuation of continuous rocuronium.Conclusion: General anesthesia could be used in the management of SRSE with the aim of controlling seizures and preventing complications arising from continuous seizures.

Background: Breast cancer prognosis and therapeutic strategies are strongly influenced by biomarker profiles, particularly HER2 reactivity, which impacts treatment selection and disease progression.Objective: To study the HER2 reactivity pattern and identify the association of HER2 pattern with various tumor factors in patients with breast cancer.Methods: This prospective study comprised of 150 surgically operated female cases of breast cancer admitted to the Department of Pathology for ER, PR, and HER2 testing between December 2015 and October 2017.Results: Of 150 cases, the mean age was 52 years (IQR, 41-63 years). This study showed that majority of tumors were IDC-NOS, grade 2, tumor size T2, and had negative lymph node status. HER2 negative cases were in the majority, as well as the ER/PR+ cases. Triple-negative cases were slightly higher (49 cases). When HER2 was correlated with tumor characteristics, younger patients with HER2-positive were in the majority, with the higher the tumor size is, the greater the chance for HER2 negativity. The majority of IDC cases and all ILC cases showed HER2 negativity. Both medullary cases showed HER2 positive, and one case of mucinous showed HER2 negativity with ER/PR positivity. Irrespective of ER/PR status, the majority of tumors had HER2 negativity.Conclusion: HER2/neu positively correlates with increasing age, menstrual status, tumor size, and tumor grade. No association is found between histological type, lymph node status, and ER/PR. This study also reveals that patient with higher levels of HER2/NEU-overexpression had statistically significant lower levels of ER/PR-positive tumors. In addition, when Her2 neu is positive in tumors, along with ER and PR, it is mostly high-grade.

Background: Hormonal imbalances play a pivotal role in female infertility, affecting various endocrine pathways that warrant comprehensive evaluation.Objective: To analyze correlations between thyroid-stimulating hormone (TSH), prolactin, luteinizing hormone (LH), follicle-stimulating hormone (FSH), estrogen, and progesterone in women with infertility.Methods: This retrospective observational study was conducted at the Department of Obstetrics and Gynecology of Prakash institute of Medical Sciences, India, between January 2024 and December 2024. Medical records of 140 women (90 with primary infertility and 50 with secondary infertility) aged 19–45 years were analyzed over a one-year period. Hormonal profiles including TSH, prolactin, LH, FSH, estrogen, and progesterone were analyzed. Statistical analyses were performed using the SPSS 23.0 software and a p-value of less than 0.05 was considered statistically significant.Results: Women with primary infertility were younger and had a shorter duration since marriage compared to those with secondary infertility (p<0.001). Irregular menstrual cycles were significantly more common in primary infertility cases (p=0.002). Thyroid dysfunction was seen in 25% of cases, with hypothyroidism as the most common thyroid function abnormality (14.9%). A strong positive correlation was found between TSH and prolactin levels (r=0.821, p<0.05), whereas a significant negative correlation was present between TSH and LH (r=-0.73, p<0.05) and FSH (r=-0.41, p<0.05). Correlations between TSH and estrogen or progesterone was not found to be statistically significant (P>0.05).Conclusion: TSH levels significantly correlate with prolactin, LH, and FSH levels in women with infertility. These findings underscore the importance of comprehensive endocrine evaluation of women with infertility to optimize diagnosis and management strategies.

Background: Monitoring progression in interstitial lung diseases is essential for timely intervention, with spirometry, DLCO, and 6MWT serving as key functional tests.Objectives: To evaluate disease progression in idiopathic and collagen vascular interstitial lung diseases (ILD) using pulmonary function parameters, including spirometry, DCLO (Diffusing Capacity of the Lungs for Carbon Monoxide), and the six-minute walk test.Methods: This prospective observational study was performed from January 2023 to December 2024 at Shadan Institute of Medical Sciences , Hyderabad, India. In this study, the pulmonary function in 51 ILD patients were assessed using spirometry, DLCO, and the six-minute walk test. Patients underwent detailed clinical evaluation, routine investigations, chest X-ray, ABG analysis, and HRCT to confirm ILD. Those suspected of CTD-ILD had RF and ANA testing, with a complete ANA profile if positive. Subjects were categorized into IPF and CTD-ILD groups. Pulmonary parameters were compared, and standard treatments were administered. Six deaths occurred during follow up period. For statistical purposes p value less than 0.05 was taken as statistically significant.Results: Fifty-one patients with diffuse parenchymal lung disease were included, with idiopathic pulmonary fibrosis (IPF) (46.4%) and connective tissue disease-associated ILD (CTD-ILD) (44.6%) as the main types. The CTD-ILD patients were younger (mean age 48.64 vs. 61.80 years, p=0.0006) and predominantly female. IPF patients had lower six-minute walk distance (239.73 vs. 312.60 meters, p=0.0066) and SpO2. Strong correlations were observed between lung function parameters in both groups. However, 6MWT showed no correlation in CTD-ILD.Conclusion: In ILD patients, FVC and DLCO were found to be reliable for disease monitoring, while simpler tests like 6MWT and FVC proved to be useful in resource-limited settings. Further research is needed to confirm their role in tracking IPF progression and treatment response.

Background: Infective endocarditis remains a life-threatening condition with high in-hospital mortality, necessitating identification of predictive clinical factors.Objective: To identify predictors of in-hospital mortality in infective endocarditis (IE) patients.Methods: This single-center retrospective study included 88 patients with IE aged ≥ 18 years treated at Dr. Hasan Sadikin General Hospital, Bandung, Indonesia, between September 2019 and May 2023. During hospitalization, data regarding clinical characteristics, blood cultures, and clinical outcomes were assessed to identify the predictors of in-hospital mortality. Data were analyzed using chi-square and binary logistic regression.Results: Among 88 patients with IE, the majority were male (56.8%) and aged < 60 years old (78%). More than two-thirds of patients had valvular heart disease. During treatment, 22 patients (25%) underwent cardiac surgery, and the total in-hospital mortality rate was 35.2%. Although not statistically significant, in-hospital mortality rate was lower in operated patients (22.7% vs 39.4%). In multivariate analysis, septic shock was the only significant predictor of in-hospital mortality (OR 40, 95% CI: 4.7–339, p 0.001)Conclusion: Septic shock is a strong predictor of in-hospital mortality among patients with infective endocarditis. Invasive management by cardiac surgery does not significantly decrease the mortality risk.

Background: Hypothyroidism is frequently associated with anemia and oxidative stress, necessitating exploration of biomarkers like Osteopontin to better understand disease mechanisms.Objective: To explore the association between Osteopontin, oxidative stress, and antioxidant capacity in hypothyroid woman with or without anemia.Methods: The study was conducted at the Santosh Medical College Department of Biochemistry in Ghaziabad, India, from September 2019 to October 2021. This study was cross-sectional and recruited 360 female subjects, divided into three groups: hypothyroidism with anemia, hypothyroidism without anemia, and normal healthy controls. Osteopontin, thyroid profile, malondialdehyde (MDA) and total antioxidant capacity were measured.Results: Osteopontin, T3, T4, and total antioxidant capacity levels were significantly lower (p<0.001), and the TSH and MDA levels significantly increased (p<0.001) in female subjects experiencing hypothyroidism, with or without anemia, as compared to normal healthy female control groups. Osteopontin demonstrated significant negative relationship with TSH and MDA, while showing a significant positive relationship with T3, T4, and total antioxidant status in both studied groups.Conclusion: Osteopontin and oxidative stress/antioxidant status significantly correlate in female subjects experiencing hypothyroidism, with or without anemia. In these patients, Osteopontin might be a useful biomarker for evaluating antioxidant levels and oxidative stress.

Background: Chronic smoking has systemic vascular effects, including alterations in ocular blood flow and choroidal thickness, impacting visual health.Objective: To compare choroidal thickness (CT) in chronic smokers and nonsmokers using optical coherence tomography and to evaluate the effect of smoking duration on CT based on pack-year quartiles (PYQ).Methods: This was a case-control study conducted at the Regional Institute of Ophthalmology, Medical College, Kolkata, India between January 2023 and June 2024. Choroidal thickness was assessed in 120 cases (60 smokers and 60 nonsmokers) over a period of 18 months. Choroidal thickness was measured using Enhanced Depth Imaging Spectral-Domain Optical Coherence Tomography (EDI SD-OCT) at the sub foveal region and 1.5 mm away in the superior, inferior, nasal, and temporal directions. CT between smokers and nonsmokers was compared. Statistical analysis was performed using the SPSS 23.0 software and a p-value of less than 0.05 was taken as statistically significant.Results: The study analyzed age distribution, ocular parameters, and choroidal thickness in 60 smokers and 60 nonsmokers. The mean age in smokers and nonsmokers was found to be 43.1 ± 7.2 and 40.8 ± 11.4 years respectively. Smokers were found to have a significantly lower sub foveal CT compared to nonsmokers (272.42 ± 13.57 µm vs. 284.94 ± 14.15 µm, p<0.05). Increased smoking exposure significantly correlated with progressive choroidal thinning (p<0.05). Other ocular parameters, such as intraocular pressure (p=0.235) and axial length (p=1.0), were found to be comparable in both groups (p>0.05).Conclusion: There significant choroidal thinning in chronic smokers as compared to nonsmokers with a dose-dependent effect linked to higher smoking exposure. These findings suggest a smoking-induced vascular compromise in the choroid.

Background: High-Resolution Computed Tomography (HRCT) plays a crucial role in the evaluation of interstitial lung diseases, offering detailed imaging for accurate diagnosis.Objective: To evaluate diagnostic precision and clinical relevance of High-Resolution Computed Tomography (HRCT) in evaluating Interstitial Lung Diseases (ILDs).Methods: This observational study analyzed HRCT images from 30 patients using a multi-detector CT scanner. The study was conducted at the Department of Radiodiagnosis of Gian Sagar Medical College and Hospital, India, in a period of one year (January 2024 to December 2024). Images were reviewed by two radiologists for various features, including ground-glass opacities, reticulations, honeycombing, and traction bronchiectasis. The patterns were classified as definite UIP, probable UIP, or suggestive of chronic HP or NSIP.Results: Eighteen patients (60%) showed basal-predominant honeycombing, reticulations, and traction bronchiectasis consistent with definite UIP. Six of these also exhibited upper lobar emphysema, categorized as Combined Pulmonary Emphysema and Fibrosis (CPFE). Another six patients with NSIP displayed subpleural curvilinear opacities, fine reticulations, and ground-glass abnormalities. Six (20%) patients with chronic HP showed diffuse ground-glass opacities and traction bronchiectasis, primarily in the upper lobes with air trapping on expiratory scans.Conclusion: This case series demonstrates the diverse HRCT findings in ILD, underscoring the importance of HRCT in diagnosis and prognosis. Larger studies with histopathological confirmations are needed to refine these diagnostic insights.