NKP Salve Institute of Medical Sciences and Lata Mangeshkar Hospital

Background: Smokeless tobacco (SLT) use remains a major public health concern in India, particularly among women living in urban slum settings. Evidence on its prevalence and determinants in this population remains limited. Methods: A community-based cross-sectional study was conducted among 300 women residing in urban slums of Vidarbha. Data on socio-demographic characteristics, SLT use, and behavioral factors were collected through face-to-face interviews. Statistics summarized participant characteristics and prevalence. Bivariate analysis using the Chi-square test estimated associations, while multivariate logistic regression was used to identify independent determinants. Results: The prevalence of SLT use was 21.3%. In bivariate analysis, SLT use was associated with older age, low educational attainment, employment status, and family tobacco exposure. In the adjusted model, low educational attainment (AOR = 8.61; 95% CI: 4.17-19.2) and employment status (AOR = 2.64; 95% CI: 1.42-5.01) emerged as independent determinants. Khara was the most commonly consumed product. Peer pressure, indigestion-related reasons, and thrill-seeking behavior were the most frequently reported reasons for initiation. Conclusion: SLT use is highly prevalent among women in urban slums, driven primarily by educational and occupational factors. Targeted, community-based interventions focusing on literacy and socio-behavioral change are essential to reduce SLT use and associated health risks.

Hypertension is a leading cause of cardiovascular morbidity and mortality globally, with particularly low control rates in India. Beyond controlling blood pressure (BP), effective management must address associated comorbidities such as cardiovascular disease (CVD), chronic kidney disease (CKD), and type 2 diabetes mellitus (T2DM). A multidisciplinary panel of experts, including cardiologists, nephrologists, and physicians, developed this consensus through six advisory board meetings. A comprehensive literature review of randomized controlled trials and systematic reviews published between 2019 and 2025 was conducted via PubMed and Google Scholar. Key topics included pharmacological and non-pharmacological management of hypertension, combination therapy, and comorbidity-focused treatment strategies. Early screening for hypertension-mediated organ damage and the use of combination therapy, specifically telmisartan and cilnidipine for their complementary benefits, were emphasized. Evidence showed improved BP control, reduced proteinuria, and organ protection in individuals with CVD, CKD, and T2DM. Non-pharmacological interventions such as dietary modification, physical activity, smoking cessation, stress management, and adherence to therapy through fixed-dose combinations were also endorsed. This expert consensus supports a comprehensive, patient-centered approach to hypertension management in India. Available evidence suggests that cilnidipine and telmisartan may offer potential benefits beyond BP reduction, largely based on pharmacologic properties and surrogate outcomes. Future large-scale, randomized, comparative outcome trials are needed to better define the relative clinical benefits of this combination.

Vertebrojugular arteriovenous fistulas (AVFs) are rare vascular anomalies characterized by an abnormal communication between the extracranial vertebral artery and the internal jugular vein. They may arise from trauma, iatrogenic injury, or, rarely, occur spontaneously. We present a 50-year-old male who sustained an iatrogenic injury and developed progressive pulsatile swelling on the right side of the neck, which raised suspicion of an underlying vascular lesion. Subsequent carotid Doppler, MRIwith non-contrast angiography, and digital subtraction angiography revealed a vertebrojugular AVF. This case emphasizes the importance of maintaining a high index of suspicion for AVFs in failed central catheter insertions and highlights the effectiveness of early diagnosis in improving patient outcomes.

Dear Editor, We present a rare case of coexisting mesial temporal lobe sclerosis (MTLS) and systemic sclerosis (SSc), presenting with manifestations as cognitive decline, seizures, and psychiatric symptoms in the form of sadness, mood, irritability, and decreased interaction. This case highlights the diagnostic and therapeutic challenges faced by the overlapping of neurological, autoimmune, and psychiatric conditions. A 30-year-old right-handed female school teacher presented with a history of progressive cognitive decline, episodic forgetfulness, restlessness, and palpitations for four months. She reported frequent headaches, described as dull and bilateral, without any specific aggravating factor. In October 2023, she experienced two episodes of generalized tonic-clonic seizures, each episode lasting 2–3 minutes, characterized by involuntary jerking of all four limbs, uprolling of eyeballs, and post-ictal confusion. There was no history of tongue biting or urinary incontinence. Initial treatment with levetiracetam controlled the seizures, but no improvement in the cognitive symptoms. Psychiatric evaluation revealed mood lability, social withdrawal, and paranoid ideation. Neurological examination showed severe cognitive impairment Mini Mental Status Examination (MMSE: 16/30), Montreal Cognitive Assessment (MoCA): 16/30), and impaired recall. MRI Brain (T2/FLAIR) revealed bilateral hippocampal hyperintensities with volume loss consistent with MTLS, autoimmune panel, that is, ANA blot: Positive for Scl-70 (anti-topoisomerase I), confirming systemic sclerosis SSc. The coexistence of MTLS and SSc is exceptionally rare, which raises questions about shared pathophysiology.[1-3] Potential mechanisms include: Vascular Dysfunction: SSc-related microvascular ischemic changes can contribute to hippocampal damage;[1]Autoimmune Inflammation: Scl-70 antibodies might cross-react with neuronal antigens, resulting in hippocampal sclerosis; and Psychosocial Stressors:[2] Chronic psychological stressors worsen cognitive deficits via glucocorticoid-mediated hippocampal atrophy.[3] Management involved a multidisciplinary team (neurology, rheumatology, and psychiatry). The patient was started on Desvenlafaxine for depressive symptoms, risperidone for irritable behavior, oxcarbazepine (seizures/mood stabilization), and for forgetfulness, donepezil, memantine (5 + 5), and prednisolone. Over 3 weeks, her symptoms improved, underscoring the importance of an integrated multidisciplinary approach. This case highlights the importance of considering autoimmune pathology in psychiatric and cognitive presentations. Future research should explore neuro-autoimmune interactions and the role of immunomodulation in such comorbidities. Declaration of patient consent The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed. Authors contribution Concept, design: RB, YV, SG, SSB; Data acquisition & manuscript preparation: YV; Manuscript review and editing: RB, SG, SSB. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Parosteal lipomas are rare benign mesenchymal tumors consisting of mature adipocytes arising in close association with the periosteum. It accounts for less than 0.3% of all lipomas and is most often seen in the long bones of the extremities. These lesions are slow-growing and often asymptomatic, which can delay clinical recognition. Due to their proximity to bone, they can occasionally cause cortical remodeling or reactive bone changes, making radiological evaluation essential for an accurate and definitive diagnosis. We report a case of a 51-year-old female who presented with a gradually progressive swelling over the medial aspect of the proximal thighfor one year. The patient denied any priorhistory of traumaor any surgical procedure. On local examination, the swelling was soft in consistency, non-tender, and immobile. The overlying skin was normal, with no ulceration, erythema, or discoloration,and there was no associated warmth or fluctuation. On functional assessment, there was no restriction in joint movements, and neurovascular examination of the limb was normal. Routine laboratory investigations were within normal limits. Parosteal lipomas are rare entities that can be clinically mistaken for other soft-tissue or periosteal masses. Their characteristic attachment to the bone surface differentiates them from subcutaneous lipomas. Imaging modalities such as MRI play a crucial role in delineating their composition and relationship to adjacent structures. Surgical excision remains the treatment of choice, with an excellent prognosis and negligible recurrence risk. This report highlights a rare presentation of parosteal lipoma of the thigh in a 51-year-old female. Imaging findings can aid in timely diagnosis, prevent misclassification as a malignant lesion, and guide appropriate management.

Background: Attitude of medical students and intern doctors toward mental illness is of great importance. They are likely to encounter and care for these patients as doctors. Previous studies observed that 68% of the students felt persons with mental illness (PMI) should not be treated with other patients. Seventy percent of students agreed on the disrespectful attitude of other staff toward PMI. Studies also noticed a significant change in attitude toward mental illness after undergoing psychiatry training programs. Aims and Objectives: The aims and objectives of this study were to assess the attitude of intern doctors toward mental illness and to study the impact of the psychiatry clinical rotation program on their attitude. Materials and Methods: This prospective and interventional study was carried out in a tertiary care hospital for 10–12 months. Institutional ethics committee approval was taken, a total of 132 doctors were selected, and attitude toward mental illness scale was applied on baseline and after completion of clinical rotation. Results: Attitude toward mental illness score on baseline was 111.32 ± 5.15 and after completion of rotation program was 104.61 ± 4.44. Significant improvement was noted post completion of the clinical rotation program (P < 0.001). Conclusion: Thus, complete holistic training increased their awareness about mental illness. It also helped in building empathy toward PMI. Innovative learning and teaching methods played a key role in enhancing their scientific knowledge about psychiatric illness and its treatment. Hence, this program was beneficial in changing their attitude and perception toward psychiatric illness.

Typhoid fever, measles, and rubella continue to contribute significantly to childhood morbidity and mortality in India. In line with WHO recommendations for co-administration of Typhoid Conjugate Vaccine (TCV) and measles–rubella (MR) vaccine at 9 months of age, this phase IV, randomized, open-label, multicenter clinical trial was conducted to assess their immunological compatibility and safety when administered concomitantly. A total of 900 healthy Indian infants aged 9–10 months were randomized into three groups: Group A received TCV and MR vaccine concomitantly; Group B received MR on Day 0 and TCV on Day 28; Group C received TCV on Day 0 and MR on Day 28. Subjects were followed for 6 months after concomitant/last vaccination. Seroconversion rates (SC) in Groups A/B/C at Day 28 were 90.2%/75.3%/89.5% for anti-Vi; 80.4%/75.2%/77.7% for anti-measles, and 87.7%/84.0%/85.2% for anti-rubella antibodies. By study end, SC for anti-Vi was 87.1%/71.6%/83.0%, while SC for anti-measles and anti-rubella reached ~90% and ≥98%, respectively, across all groups. Geometric mean titers increased significantly for all antigens, with no evidence of immunological interference. Safety assessments showed adverse events in 23.9%/32.0%/32.7% participants in Group A/B/C. Most adverse events were mild, and only one serious adverse event was reported. These findings support the co-administration of TCV and MR vaccine as a safe and effective strategy.

Abstract: BACKGROUND AND OBJECTIVES: Preterm birth (PTB) is a significant concern due to its association with increased neonatal morbidity and mortality. It is defined as delivery before 37 weeks of gestation. The cervix, the lower part of the uterus, plays a crucial role in maintaining pregnancy through its structural integrity. Shortening of the cervix has been linked to an elevated risk of preterm labor and delivery. Cervical length (CL) measurement during the first trimester of pregnancy has emerged as a valuable tool in predicting the risk of PTB. As cervical ripening start in the second trimester and start dilating in the third trimester which results in variation in CL which may affect fetal outcome. In addition to this, the lower uterine segment “develops” (thins out and becomes more integrated with the body of the uterus) allowing the intrauterine contents to exert direct pressure on the cervix. Various methods have been developed to assess CL. They include single-line, two-line, and tracing techniques on ultrasound. Very less literature is available on the comparison of these three methods. MATERIALS AND METHODS: In this diagnostic prospective study, 40 participants (20 in second trimester and 20 in the third trimester) who were asymptomatic pregnant females between 17 and 45 years of age were selected. Transvaginal sonography (TVS) was done using Samsung RS80A, Samsung RS70A, and Samsung V7 machine with transvaginal probe frequency of 8–10 MHz. Image is magnified so that cervix occupies approximately 50%–75% of the image. The cervix is measured with three different methods single-line, two-line, and tracing method. RESULTS: The mean CL was 32.8 mm (standard deviation [SD]: 4.4) with the single-line method 34.4 mm (SD: 4.7) with the two-line method and 34.5 mm (SD: 4.7) with the tracing method. Both intra- and interoperator agreements were high. The degree of curvature of the cervical canal was variable, with a resultant variability in the difference between the single straight-line measurement and the other two types of measurement. CONCLUSION: Both two-line and tracing methods yield larger measurements than the single-line technique. These do not show statistical differences. Straight-line measurement significantly underestimates the actual CL due to curvature of the cervix in the second and third trimesters.

ABSTRACT Papillary hidradenoma is a diagnostically challenging benign entity. Mostly affecting women in their reproductive years, this tumor arises from anogenital mammary-like glands of vulva. A tiny nodule over the vulva was discovered by a 43-year-old woman who complained of dysmenorrhea and menorrhagia for two months. The vulval nodule was removed in addition to a total vaginal hysterectomy. The histopathology suggested malignant transformation in papillary hidradenoma. It is crucial to distinguish vulvar lesions from sexually transmitted diseases and other neoplastic vulvar conditions. The tumor is quite rare and requires clinical suspicion in reproductive-age women for excision and histological evaluation for accurate diagnosis.

Tuberculosis of the larynx is a rare entity usually secondary to pulmonary TB, which develops due to direct spread of mycobacterium bacilli to the larynx from contaminated sputum or by hematogenous spread. The most common site for infection with Mycobacterium tuberculosis is the lung, but any site may be secondarily or even primarily involved. Tuberculosis in India is a disease of public health importance, although recent data have shown a decline in the prevalence of and mortality from tuberculosis in India. Primary laryngeal tuberculosis is a very rare entity and it results from inhaled tubercle bacilli settling directly on the larynx. The incidence of laryngeal tuberculosis is less than 1% of all cases of tuberculosis. The pathologic hallmark of tuberculosis is formation of caseating granulomas that can give rise to an infiltrative mass that may mimic malignancy.