Maharaja Krishna Chandra Gajapati Medical College and Hospital

Lymphadenopathy diagnosis requires accurate tools like FNAC. The Sydney System was introduced to standardize reporting, but diagnostic variability persists, necessitating localized validation. This study aimed to evaluate the Sydney System's diagnostic accuracy, sensitivity, specificity, PPV, and NPV for lymph node lesions. A two-year cross-sectional study (Nov 2022-Oct 2024) at PRM Medical College and Hospital analyzed 448 non-guided lymph node FNAs. Cases with histopathological or comprehensive clinical/radiological follow-up were included. Two cytopathologists independently categorized smears using the five-tiered Sydney System (L1-L5), integrating ancillary study results. Statistical analysis determined diagnostic metrics and Risk of Malignancy (ROM).The 21-30 age group had the most cases (31.25%). Cervical (33.92%) and unusually high supraclavicular (23.21%) lesions were common, the latter strongly correlating with malignancy. Sydney System categorization showed balanced benign (43.75%) and malignant (41.9%) diagnoses. Granulomatous lymphadenitis was frequent benign; metastatic squamous cell carcinoma and Non-Hodgkin Lymphoma (NHL) were common malignancies. ROM for Category III (Atypical) was 66.67%, with all malignant cases confirmed as NHL. Category IV (Suspicious) showed an 80% ROM. Notably, non-diagnostic Category I had a 33.33% ROM. Overall diagnostic performance was high: sensitivity 91.49%, specificity 93.10%, PPV 95.56%, NPV 87.10%, and accuracy 92.11%,. This study provides compelling evidence for the Sydney System's robust diagnostic accuracy and utility in risk-stratifying lymph node lesions. Key insights include the high ROMs for indeterminate categories (especially NHL in Category III) and the significant risk associated with non-diagnostic samples, guiding clinical management. The research confirms the Sydney System's value as a standardized tool for clinical practice.

Twin brothers, 48-year-olds, presented for regular eye checkup, both of them being known cases of seizure disorder, under medication for 30 years. Twins 1 and 2 have a best corrected visual acuity of 20/30 and a normal intraocular pressure in both eyes. The anterior segment of both patients is normal. On dilated fundoscopy, whitish, pearl-like lesions present at the disc in both eyes of both patients, with optic disc giving a ‘lumpy bumpy’ appearance with difficulty in assessing the cup-disc ratio [Fig. 1]. In optical coherence tomography of the retinal nerve fiber layer, focal RNFL thinning was noted. In B-scan ultrasonography, highly reflective foci are seen at the optic nerve head in both eyes of both patients [Fig. 2]. On visual field examination in Humphrey Visual Field testing in 30-2 test, slight visual field defects were noted inferiorly in both eyes of twin 1 [Fig. 3] and central and paracentral scotoma were seen in twin 2 [Fig. 4]. After 6 months of follow-up, no significant change in visual field defect was noticed. Their elder brother was also thoroughly examined, and optic disc drusen was not present in his eyes.Figure 1: Fundus photograph of the right eye and left eye of Twin 1 (a and b) and Twin 2 (c and d) showing lumpy bumpy appearance of optic disc depicting optic disc drusenFigure 2: B-Scan ultrasonography images of twin 1 (a) and twin 2 (b) showing hyperechoic foci at optic nerve headFigure 3: (a, b) Perimetry findings of twin 1 showing field defects in the inferior quadrant in both eyesFigure 4: (a, b) Perimetry findings of Twin 2 showing field defects like central and paracentral scotoma in both eyesDiscussion Pathophysiology may be due to enlarging calcific bodies in a crowded space, exerting mechanical stress on structures within the prelaminar scleral canal, leading to significant visual field loss. With compression, drusen may promote nonarteritic anterior ischemic optic neuropathy.[1] The slowly progressive decrease in vision may be due to the direct effect of the mechanical forces as described earlier, which cause axonal dysfunction followed by gradual axonal degeneration. The inheritance pattern of optic disc drusen is suggested to follow an autosomal dominant pattern with reduced penetrance.[2] This was an accidental finding showing characteristic changes of optic disc drusen in identical twins. Though asymptomatic, careful clinical examination and patient’s history are required, confirmed by autofluorescence or ultrasonography. Optic nerve drusen on their own does not require any treatment and has good visual prognosis, and is re-evaluated periodically.[3] Authors contributions Dr. Pramod Sharma conceptualized the article. It was designed by Dr. Pooja Pattnaik with the help of Dr Prativa Behera who also helped in literature research. All the authors contributed in intellectual content definition, data acquisition and analysis. Manuscript preparation was done by Dr. Pooja Pattnaik which was further reviewed and edited by all the authors. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patients have given their consent for their images and all clinical information to be reported in the journal. The patients understand that their names and initials will not be published and their identities will be concealed but anonymity cannot be guaranteed. Financial support and sponsorship: Nil. Conflicts of interest: There are no conflicts of interest.

The aim of this research is to evaluate the diagnostic precision of the Alvarado and RIPASA scoring systems in detecting acute appendicitis. This will be done by comparing their outcomes with histopathology, which is considered the most reliable benchmark for comparison. Accurate and prompt identification of acute appendicitis is crucial in order to avoid complications such as perforation and peritonitis. Over the years, several clinical scoring systems have been developed to aid in the diagnosis of acute appendicitis. The RIPASA (Raja Isteri Pengiran Anak Saleha Appendicitis) and Alvarado scoring systems are well recognised in the medical field. It is essential to do a comparison examination of these two scoring systems because to the possible changes in sensitivity, specificity, and overall diagnostic accuracy.This study included 145 male and female patients who presented with right iliac fossa discomfort and were thought to have acute appendicitis. Two diagnostic grading systems were used to guide surgical choices. Alvarado Score: Patients having a score of 7 or above were subjected to an appendectomy. RIPASA Score: Patients with a score less than 12 also had an appendectomy. 145 individuals included between the ages of 13 and 60, the Alvarado score was found to have a sensitivity of 34.4%, specificity of 75.8%, diagnostic accuracy of 51%, positive predictive value of 68.2%, and negative predictive value of 43.5% for diagnosing acute appendicitis. On the other hand, the RIPASA score performed better, with a sensitivity of 94.2%, specificity of 94.8%, diagnostic accuracy of 94%, positive predictive value of 96.5%, and negative predictive value of 91.6%. In the adult Pakistani population, the RIPASA scoring system demonstrates superior accuracy, sensitivity, specificity, PPV, and NPV compared to the Alvarado score, with a lower rate of negative appendectomies.

variational derivation of the Dirac equation for a spin-half field on a curved background. ​The action considered contains three key terms: ​The minimally coupled Dirac term. ​A scalar curvature coupling term. ​A Hermitian derivative coupling to the Riemann tensor. ​The derivation details all necessary foundational assumptions, including metric compatibility, spinorial compatibility, antisymmetry of the spin connection, and the contracted Bianchi identity. Every step in the variational calculation is explicitly shown, which includes integration by parts and statements about boundary terms. The final equation of motion is derived in manifestly covariant form.

Women with autoimmune diseases such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and others face a disproportionate burden of cardiovascular disease (CVD), in part due to inflammation-driven dyslipidemia. Unlike classical metabolic dyslipidemia, these lipid abnormalities are characterized by low high-density lipoprotein (HDL) cholesterol, elevated triglycerides, dysfunctional HDL, and increased oxidized low-density lipoprotein. The interplay of chronic inflammation, immune dysregulation, hormonal factors, and treatment-related effects contributes to a unique lipid phenotype that amplifies CVD risk in women. This narrative review explores the epidemiology, pathophysiology, and clinical manifestations of dyslipidemia in SLE and RA, with an extension to other autoimmune diseases such as psoriatic arthritis, Sjögren’s syndrome, systemic sclerosis, and autoimmune thyroid disorders. Management strategies, including early screening, inflammation control, statin therapy, and gender-specific considerations, are highlighted. The article underscores the urgent need for tailored risk assessment tools and therapeutic approaches to mitigate premature cardiovascular morbidity and mortality in this vulnerable population.

Abstract The current study was conducted to determine the relationship between HbA1c and renal markers (urea, creatinine and uric acid and lipid profile (Total cholesterol, triglycerides, HDL, LDL and VLDL cholesterol) in patients with type 2 diabetes. Participants in this control trial were to be between the ages of 35 and 45, regardless of gender. Three groups were formed out of them. Group 1 consisted of fifty healthy, normal people who had no family history of diabetes. Fifty patients with prediabetes were in group 2. 50 individuals with diabetes from the same population were part of Group 3. Participants in all three groups were asked to fast peripheral venous blood samples, which were then examined for serum uric acid, fasting blood sugar, renal markers, lipid profile and HbA1c levels. A direct relationship with blood sugar and HbA1c was observed with serum urea, creatinine,, uric acid ,cholesterol, TGL, HDL, LDL and VLDL. The measurement of HbA1c levels is important not only for monitoring of diabetes but also renal failure, gout and dyslipidemia associated with cardiovascular disease because some parameters were not significantly increased with increasing HbA1c level. Therefore, this study proves that even poor glycemic control (even if HbA1c levels go beyond 14.8%) between the age group 35 and 45 years old would not cause any severe complications but uncontrolled diabetes which exists more than ten years after crossing 50 years of old might cause severe complications like amputation, cataract, renal failure, gout and cardiovascular disease etc.