Command Hospital Air Force

The progressive process from normal oral tissue (ONT) to precancerous lesions (oral dysplasia [OD], leukoplakia-oral precancerous lesion [OPL]) and ultimately to oral squamous cell carcinoma (OSCC) involves dynamic molecular and immunological alterations. Four transcriptomic datasets were analyzed using GEO2R and the R package "IOBR" for differentially expressed genes (DEGs) and immune infiltration profiling. Two-sample Mendelian randomization (TSMR) was employed to validate the causal effects of immune cells and genes on 11 oral-related cohorts. WDR66 was the only consistently upregulated DEG across all stages (ONT, OD, OPL, OSCC; p < 0.001), with expression levels increasing from premalignant to malignant tissues. Immune infiltration indicates that neutrophils and CD4+ effector memory T cells (Tem) show high correlation with OSCC and OD (these 2 cells were intersection cells in OSCC based on 3 cohorts, high correlation cells in OD based on 1 cohort). TSMR indicated that WDR66: OR M (Q1, Q3) = 0.8513 (0.8453, 0.8759), p, M (Q1, Q3) = 0.0057 (0.0029, 0.0104); CD4+ T cells: OR M (Q1, Q3) = 0.5888 (0.4556, 0.7254), p, M (Q1, Q3) = 0.0000 (0.0000, 0.0002). WDR66 emerges with its expression tightly coupled to CD4+ T cell dysfunction in OSCC.

ObjectivesDupilumab and tralokinumab are FDA-approved biological agents for the treatment of atopic dermatitis (AD). This study analyzed tralokinumab-related adverse events (AEs) reported by healthcare professionals, utilizing data mined from the FDA Adverse Event Reporting System (FAERS). Furthermore, we compared the frequency of reports for common AEs with dupilumab or tralokinumab as the primary suspect, focusing on injection-site reactions, conjunctivitis, and keratitis.MethodsDisproportionality analysis methods, including the reporting odds ratio (ROR), the Medicines and Healthcare products Regulatory Agency (MHRA) comprehensive method, the Bayesian confidence propagation neural network (BCPNN), and the Multi-item gamma Poisson shrinker (MGPS), were employed to quantify tralokinumab-associated AE signals. Then, the occurrence risk of common AEs between dupilumab and tralokinumab was further compared.ResultsAmong 1,591,367 AE reports, 1,770 identified tralokinumab as the primary suspect. Tralokinumab-related AEs affected 25 System Organ Classes (SOC), with 49 significant disproportionality primary terms (PTs) consistently detected across all four algorithms. Notable potential AEs included eczema herpeticum, generalized exfoliative dermatitis, alopecia, skin exfoliation, and blepharitis. Most tralokinumab-related AEs occurred within the first month of treatment, with a median onset time of 37 days (interquartile range [IQR]: 13–111 days). The reporting proportion of injection site reactions was significantly higher with dupilumab than with tralokinumab (p < 0.001). In contrast, tralokinumab was associated with a substantially higher reporting proportion of conjunctivitis (p = 0.001) and keratitis (p = 0.039).ConclusionThis study identified potential AE signals that could aid clinical monitoring and risk identification for tralokinumab. Additionally, close monitoring is warranted for dupilumab-associated injection site reactions and tralokinumab-associated conjunctivitis and keratitis throughout treatment.

Femoral head fractures resulting from hip dislocations are rare injuries resulting from high-velocity trauma. Garrett Pipkin, in 1957, classified these fractures into four types. All varieties are associated with hip dislocations, which are attended to as emergencies. Few cases of isolated femoral head fractures without hip dislocation have been published in the literature; we describe one such atypical variant. A 38-year-old male presented with a history of pain and swelling in his right knee following a traffic accident. After 48 hours of bed rest on ambulating, the patient had mild right hip discomfort, but hip examination was essentially normal. Radiology was repeated with plain radiographs and non-contrast computed tomography (NCCT), followed by contrast-enhanced magnetic resonance imaging (MRI) pelvis with bilateral hips. He had a fracture of the head of the femur and acetabular lip with concentric joint. Without hip dislocation, this was an unusual presentation of Pipkin Type IV fracture of the femoral head &amp; posterior acetabular lip. It was managed with open reduction and lag screw fixation of supra-foveal femoral head fracture approaching through the acetabular bony rim avulsion, which was later fixed with lag screw and spring plates. The patient recovered well. This was an unusual presentation of Pipkin type IV fracture without hip dislocation and can be missed due to a subtle presentation, not yet described in the literature. A high degree of suspicion and advanced radiology helped in the appropriate management of the case.

BackgroundThis novel study introduces an AI-integrated syndromic management system for sexually transmitted infections in resource-constrained settings. Our hybrid approach combines traditional WHO syndromic flowcharts with machine learning algorithms trained on region-specific clinical images and patient data. The objective of this study was to evaluate an artificial intelligence system augmenting WHO syndromic protocols for sexually transmitted infection (STI) management in low-resource environments.MethodsCluster-randomized controlled trial across 27 Indian facilities (9 urban/9 semi-urban/9 rural) from 2023-2025. The novel AI system combined deep learning image analysis of genital lesions (98,450 curated images) with predictive analytics of symptom patterns (63,120 historical cases). Healthcare workers (n=412) were randomized to AI-assisted (n=14 facilities) or conventional syndromic management (n=13). Primary outcomes: syndrome-specific diagnostic accuracy against NAAT/culture references, antimicrobial appropriateness.ResultsAmong 11,902 enrolled patients, AI integration demonstrated:19.3% absolute accuracy improvement for vaginal discharge syndrome versus controls (82.1% vs 62.8%, p< 0.001)39.4% higher mixed-infection detection (71.2% vs 31.8%, p=0.002)14.7% reduction in unnecessary antibiotics (RR 0.73, 95%CI 0.68-0.79)28.5% faster diagnostic decisions in rural clinics (8.2 vs 11.5 minutes, p=0.03)Image recognition achieved 94.2% sensitivity for herpetic ulcers and 89.7% specificity for syphilitic chancres. The system reduced overtreatment in urban settings by 22.1% while increasing appropriate therapy in rural areas by 31.4%. Cost per quality-adjusted life year (QALY) gained was $14.70, with 92.6% provider adoption sustained at 18 months.ConclusionThis first AI-syndemic hybrid model significantly outperforms conventional approaches in real-world Indian settings, particularly enhancing vaginal discharge management and antimicrobial stewardship. Its tier-adaptable design provides a scalable solution for Low- and Middle-Income Countries balancing diagnostic accuracy with resource constraints, addressing a critical gap in global STI control strategies.DisclosuresAll Authors: No reported disclosures

Abstract Introduction: Disembarkment Syndrome or Mal de debarquement syndrome (MdDS) is a clinical syndrome characterized by vertigo, which is non-spinning and present continuously or for most of the day. The onset of this vertigo occurs within 48 hours after the end of exposure to passive motion. Vertigo of MdDS temporarily reduces on exposure to passive motion, and it persists for more than 48 hours. The literature on this condition is relatively sparse. This study is aimed to assess the prevalence of MdDS among professional maritime workers, to assess their associated symptoms and the effect of MdDS on their quality of life (QoL). Methods: This study was a questionnaire based cross sectional survey among professional maritime workers in India. Participants were requested to respond to a set of comprehensive questions regarding demographic details, duration of sailing and symptomatology pertaining to MdDS. Diagnosis of MdDS was done by using diagnostic criteria given by Barany society. Data were compiled on an excel sheet and results were analyzed. Results: 322 maritime workers participated in the survey. Among 322 maritime workers, 107 had some form of vertigo following sailing and among them 42 maritime workers fulfilled the diagnostic criteria for MdDS as per Barany Society. The study has determined that the prevalence of MdDS among professional maritime workers in India is 13.98% of which 3.1% have “transient MdDS”, 10.25% have “persistent MdDS” and 2.48% have “MdDS in evolution”. Discussion: The main differential diagnoses for MdDS include vestibular migraine, motion sickness and persistent postural perceptual dizziness. The results of this study may aid in diagnosing this specific clinical condition, especially when faced with a diagnostic dilemma when all neurotological investigations are normal. This may help in counselling the maritime workers about the benign nature of the condition, reassurance and stress relief.

Periodontitis, a chronic inflammatory disease, and stroke, a leading cause of death and disability, share common risk factors and inflammatory pathways. However, the role of key mediators such as hypertension in this relationship remains to be fully elucidated. This cross-sectional analysis was conducted using data from the NHANES 2009-2014. Participants aged 30 years and older with complete periodontal and stroke data were included (n = 2,783). Periodontitis was classified according to standard NHANES protocols. Stroke history was self-reported. Survey-weighted multivariable logistic regression was used to assess the periodontitis-stroke association. Mediation analysis was performed to quantify the indirect association mediated through hypertension. In unadjusted models, periodontitis was significantly associated with stroke (OR: 5.69; 95% CI: 2.24-20.61). After full adjustment, this association was no longer statistically significant (OR: 1.48; 95% CI: 0.53-5.67). Mediation analysis revealed a significant indirect association of periodontitis on stroke through hypertension (indirect association coefficient = 0.3685, 95% CI: 0.085-0.868), accounting for 31.30% of the total association. The direct association was not significant. Hypertension was identified as a significant mediator in the relationship between periodontitis and stroke. The impact of periodontitis on stroke may operate primarily through its association with blood pressure, highlighting the importance of integrated management of periodontal and cardiovascular health.

Abstract Large cell neuroendocrine carcinoma (LCNEC) of the nasal cavity is a rare epithelial malignancy with only a few cases reported to date. In this article, we present a case report of a 48-year-old male, who presented with a history of epistaxis and nasal blockage for over 1 year and was initially diagnosed as undifferentiated carcinoma further confirmed as LCNEC by histological findings and immunohistochemistry. The patient was managed by neoadjuvant chemotherapy followed by concurrent chemoradiotherapy. After follow-up for 18 months, the patient continues to be in complete clinical, histopathological, and radiological remission. The following report also discusses the rarity, presentation, and various treatment modalities and their outcomes as per current knowledge. Essentially, through this article, we want to highlight the crucial role of the degree of differentiation in such malignancies, the outcome of different treatment modalities used till now, and how these aspects play a crucial role in the treatment and prognosis of such carcinomas.

A 58-year-old male experienced gustatory sweating on the left side of his face for 2 years following a left parotidectomy a decade prior. He was clinically diagnosed with Frey syndrome, confirmed by a starch-iodine test. To treat the condition, intracutaneous botulinum toxin A injections were administered at 1 cm intervals across the affected area. Each site received two units, with follow-up assessments at 2 weeks, 3 months, and biannually over 2 years. The treatment successfully mitigated sweating without complications, such as localized muscle weakness or skin changes. Frey syndrome, though benign, can socially impact patients due to its noticeable symptoms. Botulinum toxin A proves to be an effective treatment with minimal invasiveness and a high success rate, surpassing alternative topical therapies such as aluminum chloride and glycopyrronium bromide, which lack supporting randomized study data. Consequently, botulinum toxin A remains the preferred therapeutic approach for Frey syndrome.