B.J. Medical College

Background: Functional endoscopic sinus surgery (FESS) has become the preferred surgical modality for managing sinonasal disorders. Preoperative computed tomography (CT) is considered the gold standard imaging tool, but variations exist in its correlation with intraoperative findings. Assessing this association is essential for improving diagnostic accuracy and surgical outcomes. Objectives of the study were to evaluate the association between CT scan findings of the paranasal sinuses and intraoperative observations during FESS, and to determine the role of the Lund-Mackay (LM) score in grading disease severity. Methods: A prospective study was conducted on 40 patients who underwent CT imaging followed by FESS. Anatomical variations, extent of sinus involvement, and histopathological findings were analyzed. Disease severity was quantified using the LM scoring system. Results: Maxillary sinuses were the most frequently involved (92.5%), followed by ethmoidal sinuses. Ethmoidal polyps were the predominant pathology (57.5%), with antrochoanal polyps accounting for 25% of cases. A strong correlation was noted between CT and FESS findings, particularly in cases of deviated nasal septum. The LM score showed progressive increases with the number of sinuses involved, indicating its reliability in disease severity assessment. Histopathological evaluation revealed diverse pathologies, guiding individualized management. Conclusions: CT and FESS findings show significant association in evaluating sinonasal disease. CT reliably demonstrates anatomical variations and disease extent, while the LM score provides objective severity assessment. The combined use of CT and intraoperative findings enhances diagnostic precision and optimizes treatment strategies in paranasal sinus disorders.

Background: Despite the availability of effective inhaled pharmacotherapy, a substantial proportion of asthma patients fail to achieve optimal disease control. Poor inhaler technique represents a critical yet frequently overlooked barrier to effective drug delivery and clinical outcomes. This study aimed to assess the level of asthma control and evaluate inhaler technique proficiency among adult asthma patients attending outpatient clinics, and to determine the association between inhaler technique errors and asthma control status. Methods: A cross-sectional observational study was conducted across four hospital-based outpatient pulmonology and allergy clinics. A total of 520 adult patients with physician-diagnosed asthma using inhaler devices for ≥3 months were enrolled. Asthma control was assessed using the Asthma Control Test (ACT), and inhaler technique was evaluated through direct observation using device-specific validated checklists. Spirometric assessment, medication adherence (Medication Adherence Report Scale for Asthma, MARS-A), and demographic and clinical variables were systematically recorded. Results: The mean ACT score was 16.8 ± 4.6, with only 34.2% of patients achieving well-controlled asthma (ACT ≥20). Critical inhaler technique errors were identified in 56.7% of participants. The most common critical errors were failure to exhale before inhalation (42.3%), incorrect inspiratory flow rate (38.1%), and failure to hold breath after inhalation (34.6%). Patients with critical errors had significantly lower ACT scores (14.8 ± 4.2 vs. 19.4 ± 3.8, p < 0.001) and lower FEV₁% predicted (68.4 ± 16.2% vs. 78.6 ± 14.8%, p < 0.001). Multivariable analysis identified critical inhaler errors (aOR 3.18, 95% CI 2.14–4.72, p < 0.001), poor medication adherence (aOR 2.64, 95% CI 1.78–3.92, p < 0.001), and absence of prior inhaler education (aOR 2.42, 95% CI 1.62–3.61, p < 0.001) as independent predictors of uncontrolled asthma. Conclusion: The majority of asthma patients in outpatient settings demonstrate suboptimal disease control, with critical inhaler technique errors affecting more than half of users. Inhaler technique proficiency is independently and strongly associated with asthma control status. Systematic assessment and regular reinforcement of inhaler technique should be integrated into routine asthma management.

Background: Direct laryngoscopy with the Macintosh laryngoscope is the standard technique for endotracheal intubation during general anaesthesia. However, laryngoscopy and intubation can provoke sympathetic stimulation leading to tachycardia and hypertension. The Intubating Laryngeal Mask Airway (ILMA) is an alternative airway device that allows ventilation and blind tracheal intubation without direct laryngoscopy. Objective: To compare the hemodynamic responses and intubation characteristics of tracheal intubation using direct laryngoscopy and ILMA in patients undergoing elective surgery under general anaesthesia. Methods: This prospective randomized comparative study included 110 adult patients aged 18–65 years with ASA physical status I–II scheduled for elective surgery under general anaesthesia. Patients were randomly divided into two groups of 55 each: Group M underwent intubation using direct laryngoscopy with Macintosh blade, and Group I underwent intubation using ILMA. Hemodynamic parameters including heart rate, systolic blood pressure, diastolic blood pressure, and mean arterial pressure were recorded at baseline, before intubation, during intubation, and at 1, 2, 5, and 10 minutes after intubation. Intubation time, success rate, and complications were also assessed. Results: The mean intubation time was significantly shorter in Group M compared with Group I (p < 0.05). The first-attempt success rate was higher in Group M, although the overall success rate was 100% in both groups. Hemodynamic parameters showed transient increases during intubation in both groups without significant differences. Conclusion: Direct laryngoscopy provides faster tracheal intubation with a higher first-attempt success rate, while ILMA offers comparable hemodynamic stability and can be considered a feasible alternative airway device.

Background: Chronic plaque psoriasis is a systemic immune-mediated inflammatory dermatosis characterized by dysregulated cytokine networks and persistent cutaneous inflammation. Serum inflammatory biomarkers have emerged as potential objective indicators of disease activity, yet their precise correlation with clinical severity indices remains incompletely characterized. Methods: This cross-sectional study enrolled 120 patients with chronic plaque psoriasis and 60 age- and sexmatched healthy controls from the dermatology outpatient department of a tertiary care hospital. Patients were stratified into mild (PASI <7), moderate (PASI 7–12), and severe (PASI >12) groups. Serum biomarker levels were quantified using enzyme-linked immunosorbent assay (ELISA). Correlations between biomarker levels and PASI scores were analyzed using Spearman's rank correlation coefficient. Results: Mean serum levels of CRP (14.82 ± 6.41 mg/L vs. 2.14 ± 1.03 mg/L; p<0.001), IL-6 (28.67 ± 11.54 pg/mL vs. 5.23 ± 2.18 pg/mL; p<0.001), TNF-α (45.39 ± 18.72 pg/mL vs. 8.91 ± 3.44 pg/mL; p<0.001), and IL17A (38.56 ± 14.83 pg/mL vs. 6.47 ± 2.76 pg/mL; p<0.001) were significantly elevated in psoriasis patients compared to controls. All biomarkers demonstrated significant positive correlations with PASI scores, with IL17A exhibiting the strongest correlation (r=0.784, p<0.001). Conclusion: Serum inflammatory biomarkers are significantly elevated in chronic plaque psoriasis and correlate positively with disease severity. IL-17A demonstrated the strongest association with PASI, supporting its utility as a reliable serological indicator of disease activity and therapeutic monitoring.

Clostridium perfringens infections are often associated with high mortality and typically result from soft tissue infections. Stercoral colitis, a complication of fecal infection, is more frequently linked to gram-negative bacteremia. We present a rare case of C. perfringens bacteremia caused by stercoral colitis. A 62-year-old woman with advanced Parkinson's disease, dementia, and immobility presented with altered mental status. Stroke was ruled out. Blood cultures grew C. perfringens without signs of soft tissue infection. A CT of the abdomen showed stercoral colitis with fecal impaction. She was treated with a seven-day course of intravenous metronidazole and an aggressive bowel regimen. She remained hemodynamically stable and was discharged in stable condition for outpatient follow-up. This case highlights stercoral colitis as a potential source of C. perfringens bacteremia even without perforation or soft tissue involvement. Early antibiotics, bowel decompression, and nutritional support can improve outcomes in high-risk patients.

Gastric neuroendocrine tumors are uncommon neoplasms arising from neuroendocrine cells of the gastric mucosa. They are classified into three main clinical types based on underlying etiology. We present the case of a 45-year-old woman with a 6-month history of epigastric discomfort and postprandial fullness. Upper gastrointestinal endoscopy revealed a solitary 1.5 cm polypoid lesion in the gastric fundus. Histopathological evaluation confirmed a well-differentiated Grade 1 gastric neuroendocrine tumor. The patient had no history of autoimmune atrophic gastritis, and serum gastrin was only mildly elevated, supporting a diagnosis of type 3 (sporadic) gastric neuroendocrine tumor. Endoscopic snare polypectomy was performed successfully, and follow-up revealed no recurrence. This case highlights the importance of recognizing type 3 gastric neuroendocrine tumors and reinforces the role of endoscopic resection in selected small, well-differentiated lesions.

Ruscogenin, a steroidal sapogenin, is primarily derived from the genus Ruscus. It demonstrates a wide range of pharmacological actions that hold substantial promise for therapeutic use. By conducting a comprehensive examination of electronic databases including PubMed, ScienceDirect, and SciFinder, we identified studies on ruscogenin to date. This review aims at emphasizing the findings related to the bioactivities of ruscogenin, particularly its protective activities in neurological and inflammatory disorders, hemorrhoids, and cancer. Ruscogenin has been demonstrated to possess anti-ulcer, anti-osteoporotic, and skin-lightening properties as a therapeutic agent. It has also been proven effective in managing metabolic disorders by reducing inflammation and improving lipid metabolism, particularly in conditions such as non-alcoholic steatohepatitis and diabetic nephropathy. Reports indicate that it can prevent acute lung injury by protecting pulmonary endothelial cells from apoptosis and modulating inflammatory cytokines. Additionally, ruscogenin promotes neurological recovery by mitigating oxidative stress. It also shows anti-cancer properties, leading to apoptosis and hindering metastasis, particularly in pancreatic and hepatocellular carcinoma. This review summarizes the potential medical applications of ruscogenin and underscores the need for further research on its mechanisms of action.