Abstract Urachal carcinoma is a rare and aggressive type of bladder cancer that originates from the urachus, a fibrous tissue left over from the allantois, connecting the bladder to the umbilicus. We present the case of a 65-year-old man with an unremarkable medical history who presented with obstructive lower urinary tract symptoms. His imaging showed a calcific mass lesion along the anterosuperior wall of the bladder. He underwent partial cystectomy and was histologically diagnosed as urachal adenocarcinoma.

Abstract Dyadic death refers to a catastrophic event in which a homicide is committed, followed by the perpetrator’s suicide, almost immediately or soon after the homicide. This phenomenon encompasses two distinct forms: homicide suicide and suicide pact. This case report presents a rare and intriguing instance of dyadic death, where an elderly couple was found dead in their residence. Investigation revealed a multifaceted scenario characterized by marital discord, financial hardship, and mental health issues that ultimately culminated in lethal violence. This case underscores the importance of comprehending the intricate factors contributing to dyadic death. The absence of a national surveillance system for tracking dyadic deaths in India is a notable concern. This case highlights the imperative need for enhanced mental health support, financial assistance, and community-based interventions to prevent dyadic deaths.

Abstract Introduction: Liver-fatty acid-binding protein (L-FABP), a 14 kDa protein, regulates fatty acid uptake and transport. This study aimed to evaluate L-type fatty acid-binding protein as a predictor of acute kidney injury (AKI) in critically ill obstetrics patients. Methods: Nested case–control study was conducted at obstetric intensive care unit (ICU), over 18 months. After informed and written consent, 143 patients were recruited. AKI was defined according to KDIGO 2012 guidelines. Out of 140 enrolled patients, 82 developed AKI cases, whereas the remaining 58 who did not develop AKI after follow-up, controls. Samples were collected two times, first at the time of ICU admission and second after 48 h of admission. Estimation of L-FABP was done using the enzyme-linked immunosorbent assay (ELISA) technique using ELISA KIT. Results: The incidence of AKI in critically ill obstetric patients was 28.6%. 46.34% of obstetric patients had hypertension, 24.4% had antepartum eclampsia, 18.3% severe preeclampsia, and 3.7% postpartum eclampsia. 13.41% experienced hemorrhage, 7.3% had antepartum hemorrhage, and 3.7% had placenta previa. On day of admission and on day 3 L-FABP levels in cases were 2-fold higher as compared to controls, signifying that those who have L-FABP 2-fold higher have higher chances of developing AKI in future. On day 1, L-FABP at a cutoff value of >88.50 ng/mL and at area under the curve (AUC) 0.954 had sensitivity 96.3% and specificity 81%, whereas on day 3, L-FABP at a cutoff value of >118.00 ng/mL and at AUC 0.977, it was 100% sensitivity and 94.8% specificity. Conclusions: L-FABP levels were significantly higher in AKI patients, suggesting it could be a useful biomarker for early AKI prediction.

Abstract Background: The coronavirus disease 2019 (COVID-19) pandemic led to a decline in trauma admissions globally, but its impact in India remained unclear. This study analyzed trauma cases at a tertiary care center in South India, comparing admissions during the pandemic (September 2020–January 2021) with prepandemic data from 2018. Methodology: The study included a prospective analysis of trauma cases during the pandemic and a retrospective comparison using trauma data retrieved from the hospital database from the year 2018. The aim was to assess changes in trauma incidence and outcomes. Results: Trauma prevalence during the pandemic was 13.2% (3302/25,087), with a median age of 33 years (interquartile range: 21–49). Road traffic accidents (RTAs) accounted for 56% (1805/3224). Falls on level ground (FLGs) increased to 14.4% (464/3224), showing a 59.7% rise, while RTAs decreased by 14.5% in the prospective group. Severe injuries (NISS >15) were observed in 13.8% (445/3224), with 30.9% (998/3224) requiring major surgery. Among admissions, 8.6% (74/862) tested positive for COVID-19. Predictors of adverse outcomes included age over 60 (odds ratio [OR]: 0.26, 95% confidence interval [CI]: 0.12–0.53), COVID-19 positivity (OR: 0.16, 95% CI: 0.07–0.36), and NISS >15 (OR: 0.38, 95% CI: 0.19–0.7). Conclusions: The pandemic altered trauma patterns, with RTAs declining and FLGs increasing. Older age, severe injuries, and COVID-19 positivity were significant predictors of poor outcomes. These findings provide insights for optimizing trauma care during public health crises.

Abstract Background: Assessments are tools used to measure the knowledge and progress of students. It is usually associated with anxiety and fear among the students and additional work for the teachers. Taking tests repeatedly on previous learning materials has positive effects in that it is a powerful method of learning and helps to retain long-term memory. This is called the testing effect or test-enhanced learning. One of the student-centered active learning methods is the flipped classroom, which provides instructors with opportunities to engage a wide range of learning styles. Hence, the present study is undertaken to evaluate the effectiveness of test-enhanced learning on the learning outcomes in the flipped classroom. Materials and Methods: The students who gave informed consent were divided into two groups by a simple randomization method. Four histology topics were chosen. During the self-study phase, one group was given learning material in the form of PowerPoint, and the other group was given questions and asked to find the answers regarding the same topic. During the in-class session, both groups had an assessment consisting of 10 multiple-choice questions through Google Forms, followed by a routine interactive discussion session. For the next topics, the groups were crossed over. Results: The mean scores of the two groups were compared using Students’ unpaired t -test. Mean scores were higher in the testing effect group, and the scores were statistically significant. Conclusion: Hence, we conclude that the testing effect is having a positive influence on the learning abilities of the students and their knowledge.

Abstract Background: Approximately 20%–25% of people suffer from dermatophytosis worldwide. In India, this has significantly risen recently. Antifungal resistance is another major issue leading to chronic dermatophytosis. In this background, this study was done to isolate and identify the species of dermatophytes among acute, chronic and recurrent dermatophytosis and detect their antifungal susceptibility pattern. Materials and Methods: A total of 120 suspected dermatophytosis patients were subjected to KOH mount and culture. Antifungal susceptibility testing was performed on the isolates. Results: The mean age of dermatophytosis with chronic infection, recurrent infection, and acute infection was 38.52 years, 37.17 years, and 31.35 years, respectively. Females outnumbered males in chronic and recurrent dermatophytosis. Tinea corporis was the most common lesion observed. KOH mount was positive in 86 (72%) patients, whereas culture positive was noted in 68 (57%) patients. Trichophyton mentagrophytes (T. mentagrophytes) was the most common species, followed by Trichophyton rubrum (T. rubrum) and Trichophyton tonsurans (T. tonsurans) in all acute, chronic, and recurrent dermatophytosis. Minimum inhibitory concentration (MIC) for griseofulvin was 0.12–1 μg/ml for T. mentagrophytes and 1–8 μg/ml for T. rubrum . MIC for fluconazole was 0.5–128 μg/ml for T. mentagrophytes and 0.5–64 μg/ml for T. rubrum . MIC for itraconazole was 0.125–0.5 μg/ml for T. mentagrophytes and 0.03–1 μg/ml for T. rubrum . MIC for terbinafine was 0.005–0.125 µg/ml for T. mentagrophytes and 0.25–0.5 μg/ml for T. rubrum . Conclusion: T. mentagrophytes emerged as the predominant species across all clinical presentations. The observed rise in MICs, especially for fluconazole and griseofulvin, suggests emerging antifungal resistance. Routine species identification and antifungal susceptibility testing are critical for effective dermatophytosis management.

Abstract Villous adenomas are extremely uncommon in the urinary tract, particularly within the renal pelvis, and are predominantly associated with the gastrointestinal system. Their clinical presentation often mimics more routine conditions like urinary tract infections or kidney stones, making diagnosis before surgery quite challenging. We describe a rare instance involving a 54-year-old male who was diagnosed with a villous adenoma of the renal pelvis following nephrectomy. The patient had symptoms of left-sided flank pain, painful urination, and reduced urine output. Radiological investigations identified obstructive stones, pronounced hydronephrosis, and cortical thinning. Histological evaluation of the resected specimen revealed multiple villous adenomas with dysplastic epithelium and goblet cell metaplasia, in the background of pyonephrosis and intestinal-type metaplasia. Immunohistochemical staining was positive for CK7, CK20, CEA, and EMA, and no stromal invasion was observed. Given the known risk of malignant transformation, careful pathological examination is crucial. At a follow-up of 6 months, the patient exhibited no symptoms or recurrence. This case illustrates the importance of considering this rare entity in differential diagnoses and emphasizes the need for meticulous histopathological assessment to guide appropriate treatment and prevent progression to malignancy.

Abstract Mantle cell lymphoma, a rare aggressive non-Hodgkin lymphoma subtype in the nasopalatine region, an uncommon encounter by the otorhinolaryngologists, is reported. The relevance of early lymphoma subtypes diagnosis with immunohistochemistry, in addition to histopathology, for initiation of aggressive, intensive chemotherapy regimen and autologous stem cell transplantation for improved survival is discussed.