Nizam's Institute of Medical Sciences

Background: Tumor vasculature is a key driver of glioma progression, yet routine quantification depends on subjective histopathologic assessment or resource-intensive ancillary immunohistochemistry. A scalable, objective method for vascular phenotyping from routine histology remains an unmet need. Methods: We leveraged 10x Genomics Xenium spatial transcriptomics data from a glioblastoma specimen to generate molecularly resolved annotations of GBM-associated endothelial cells and pericytes across 809,041 cells. These annotations were transferred to matched H&E-stained sections to train a DINO-DETR-based object detection model using a binary classification scheme (vascular vs. other). The model was validated on four independent Xenium patient slides and applied to a retrospective cohort of 119 diffuse gliomas spanning WHO grades 2-4 (oligodendroglioma, astrocytoma, and glioblastoma) with linked survival data. Results: Binary vascular cell detection achieved a precision of 0.78, a recall of 0.63, and an F1 score of 0.70, with an overall accuracy of 98.6%. Orthogonal spatial validation confirmed that predicted vascular cells were preferentially localized within annotated blood vessel regions. In subtype-stratified survival analysis, high AI-derived vascular cell proportion was significantly associated with worse overall survival in astrocytoma patients (log-rank p < 0.019). Conclusion: Cross-modal AI training using spatial transcriptomics enables scalable, molecularly informed vascular quantification directly from routine H&E slides. Within the astrocytoma subtype, where tumor grade is most heterogeneous and vascular phenotype most variable, objective vascular quantification provides independent prognostic information demonstrating the potential of spatially supervised deep learning to extract clinically meaningful microenvironmental signals from universally available histologic material.

Winston Churchill famously said, "To improve is to change; to be perfect is to change often." In Emergency Medicine-a speciality defined by urgency, uncertainty, and decisive action-this sentiment is particularly relevant.As educators and clinicians, we must ask an uncomfortable but necessary question: Does our present system of examination truly assess the competencies required of an emergency physician?Examinations influence how students learn.ey shape priorities, determine the depth of engagement, and ultimately define the kind of clinicians we produce.Yet, there is an important distinction between examination and evaluation.An examination measures performance at a single point in time.Evaluation is broader and longitudinal-it captures growth, professional behaviour, procedural competence, communication skills, and clinical judgment over time.In a fast-paced, high-stakes speciality like Emergency Medicine, this distinction matters profoundly.Essay-type questions have historically formed the backbone of postgraduate theory examinations.ey are relatively easy to construct and allow candidates to demonstrate recall, reasoning, and organisation of knowledge.However, their limitations are well recognised.Marking can be subjective, coverage of the syllabus is often limited, and performance may reflect writing ability more than clinical competence.A single long essay on acute coronary syndrome may test theoretical understanding, but it does not determine whether a candidate can recognise a subtle STEMI on an ECG or initiate timely reperfusion in real practice.Objective-type questions offer improved reliability and standardisation.ey are easier to score and reduce examiner bias.Yet, they tend to assess recognition rather than synthesis.ey rarely evaluate communication skills, professionalism, or the ability to manage dynamic, evolving clinical situations.Short answer and problem-solving formats attempt to bridge this gap but remain constrained by time and limited sampling.Given the vast scope of Emergency Medicine-from trauma and toxicology to obstetrics, paediatrics, disaster medicine, and critical care-traditional written examinations struggle to comprehensively assess the cognitive domain within the allotted time.e competency framework outlined by the National Medical Commission reflects the true breadth of Emergency Medicine practice.It includes prehospital care, resuscitation, procedural sedation, trauma management, organ-system emergencies, point-of-care ultrasound, medicolegal responsibilities, toxicology, and environmental injuries.Importantly, it also emphasises psychomotor skills-multiple defined procedural competencies-as well as affective attributes such as communication, leadership, teamwork, ethical reasoning, and professionalism.Can these domains be adequately measured through four written theory papers and a conventional

Objective This study was designed to test if multidetector computed tomography-derived epicardial fat parameters like epicardial fat volume, thickness, and attenuation can predict obstructive coronary artery disease in a South Indian Population. Methods All 60 patients underwent a coronary angiogram using 128-slice multidetector computed tomography. Computed tomography coronary angiogram studies were evaluated for coronary artery calcium score, presence of plaque, type of plaque, epicardial fat volume, and degree of coronary stenosis. Results 60 patients had a mean age of 51.7 ± 11.4 years. Obstructive coronary artery disease (≥50% luminal narrowing) was found in 91.7% of males. Various risk factors for coronary artery disease were diabetes mellitus (40%), hypertension (55%), hyperlipidemia (58.33%), smoking (15%), and body mass index >25 (41.67%). These risk factors were higher in the “obstructive coronary artery disease” group than in the “no/non-obstructive coronary artery disease” group, with a statistically significant correlation. Mean epicardial fat volume for the studied population was found to be 114.26 ± 45.68 cm 3 with values ranging from 38.55 cm 3 to 270.08 cm 3 . The mean epicardial fat volume of “obstructive coronary artery disease” group was found to be higher, that is, 137.69 ± 29.44 cm 3 compared to “no/non-obstructive coronary artery disease” group, which was 108.4 ± 47 cm 3 , showing a statistically significant correlation ( P = .046). Multiple variables showed a positive correlation of epicardial fat volume with the increasing degree of coronary artery stenosis. Epicardial fat volume demonstrated a statistically significant correlation with age ( P = .007), hypertension ( P = .001), hyperlipidemia ( P = .034), smoking ( P = .002), and body mass index ( P < .001). Epicardial fat volume also showed a statistically significant correlation with the epicardial mesenteric fat area ( P < .001), calcium score ( P = .048), and epicardial fat thickness ( P < .001). An increase in epicardial fat volume was observed with higher calcium score categories, showing a statistically significant correlation ( P = .02). Based on the receiver operating characteristic curve, an optimal cutoff value of >110.48 cm 3 was obtained, which shows a sensitivity and specificity of 91.67% and 60.42%, respectively. Epicardial fat volume (multidetector computed tomography) is a significant imaging biomarker for predicting obstructive coronary artery disease with a cutoff value of >110.48 cm³ for differentiating.

Calcinosis cutis involves the deposition of calcium salts in the skin or subcutis. As the skin is not a typical site for calcium storage, this is always a pathological process. It can manifest at any age, vary in size and location, and arise from different pathogenic pathways. The main types of calcinosis cutis include: dystrophic, metastatic, idiopathic, iatrogenic, and calciphylaxis. Treatment strategies include: pharmacotherapy, surgery, or a combination of both, tailored to the specific clinical characteristics. A 54-year-old male presented with itchy lesions on the buttocks of 4 years duration. Initially, the lesions appeared as an asymptomatic nodule, gradually increasing in size over time, with extrusion of white, hard, and chalky-like material. The itching was severe; he had a history of poor response to intermittent treatment with medications from local doctors. There were no symptoms suggestive of metabolic, autoimmune, or malignant disorders. Physical examination revealed a large, hyperpigmented, butterfly-shaped plaque measuring 20 cm × 25 cm with asymmetrically distributed white nodules on the buttocks [Figure 1]. All nodules were small, <0.5 cm in size, painless, and firm to hard in consistency. The skin overlying the nodules was shiny, with whitish points indicating underlying calcium deposition.Figure 1: Plaque on the lower back with white chalk-like material extrudingLaboratory investigations, including serum calcium, phosphorus, parathyroid hormone, vitamin D, uric acid, alkaline phosphatase, and lipid profile, were all within normal limits. Based on these findings, a diagnosis of idiopathic calcinosis cutis was made. A 4-mm skin punch biopsy was performed from the active edge of the lesion. Histopathology revealed multiple foci of calcification within the dermis [Figure 2]. Higher magnification showed foci of calcification with surrounding inflammatory infiltrate [Figure 3]. Von Kossa staining for calcium was not performed in this case. The patient was referred to the plastic surgery department for serial excision in multiple stages.Figure 2: Dermis showing multiple foci of calcification (hematoxylin and eosin ×100)Figure 3: Higher magnification showing foci of calcification with surrounding inflammatory infiltrate (hematoxylin and eosin ×400)Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Parvovirus B19 (PVB19) is a clinically important cause of refractory anemia in kidney transplant recipients (KTRs). Data from low- and middle-income settings remain scarce despite high transplant volumes. This study evaluated the clinical spectrum, management practices, and outcomes of PVB19 infection across major transplant programs in India. We conducted a retrospective multicenter cohort study across 14 tertiary transplant centers. All KTRs with PCR-confirmed PVB19 infection and complete clinical data were included. Clinical features, bone marrow findings, immunosuppressive (IS) adjustments, intravenous immunoglobulin (IVIG) use, and patient and graft outcomes were analyzed. A total of 135 KTRs were identified. Median time to infection was 11 weeks posttransplant. Anemia was universal, not frequently accompanied by leukopenia (17.7%) or thrombocytopenia (14.8%). Bone marrow examinations (n=34) demonstrated giant proerythroblasts or pure red cell aplasia. IS reduction was implemented in all patients; most commonly, complete MMF withdrawal (61.5%). IVIG was administered to 90% (median cumulative dose 100g). Overall, 97% achieved hematologic recovery, with a median response time of 20 days. Recurrence occurred in 4.4%. At a median follow-up of 18 months, graft survival was 92.6%; graft loss (n=10) was primarily due to antibody-mediated rejection, and no deaths were attributable to PVB19. PVB19 infection represents an important consideration in the differential diagnosis of early posttransplant anemia in KTRs. Timely PCR testing and pragmatic treatment strategies can achieve favorable hematologic and graft outcomes in resource-constrained settings.

Background: Thyroid nodule is common endocrine disease. FNAC is gold standard but not sensitive test. Ultrasonography features are known for risk stratification of thyroid nodule, and identifying which nodules can be triaged for repeat FNAC after negative FNA results as well. Many ultrasound risk stratification classifications of thyroid nodule are existing. But, none of these classification systems have been widely adopted worldwide due to their inherent limitations. Hence scientific data on USG thyroid needs updation to enhance the diagnostic performance of ultrasonography. Aims and Objectives: To assess the diagnostic performance of Grayscale sonography using ATA thyroid nodule sonographic patterns; and doppler sonography using spectral doppler parameters, i.e., RI and PI alone and in combination in determining benign and malignant thyroid nodule compared to gold standard FNAC. Materials and Methods: Prospective Observational Cross sectional diagnostic study. On all patients gray scale HRUS, Doppler sonography performed. Resistance Index (RI) and Pulsatility Index (PI) were assessed with spectral doppler technique. Results and Summary: In our study diagnostic performance of quantitative doppler parameters, i.c., RI and PI evaluated with ROC analysis revealed RI (AUC -0.813) is better predictor for malignancy than PI (AUC -0.788). An optimum cutoff of RI is&gt;0.67. with good sensitivity 73.7%, specificity 81.2%, PPV 60.90%, NPV 88.6% to distinguish malignant from benign lesion. Conclusion: In our study quantitative doppler parameter, i.c., RI alone showed higher diagnostic performance to distinguish malignant from benign lesion compared to gray scale sonography and combined gray scale and doppler sonography.

Background The comparative efficacy of epidural bupivacaine with Magnesium sulphate and bupivacaine combined with Tramadol in providing postoperative analgesia remains controversial.This study aims to assess the efficacy of epidural postoperative analgesia using a combination of 0.125%of Bupivacaine with 50mg MgSO4, compared to 0.125%of Bupivacaine with 50mg tramadol in patients undergoing surgeries for the lower limbs. Method 60 patients classified as ASA grade I and II were randomly divided into two groups, Group I and Group II, each containing 30 patients. Group I received a total of 9 ml of 0.125% bupivacaine (8 ml) combined with 50mg tramadol (1 ml), while Group II was given 9 ml of 0.125% bupivacaine (8 ml) with 50mg MgSO4 (1 ml). The analgesic effectiveness was evaluated by the onset of analgesia, duration of analgesia, quality of analgesia, and the time taken to administer the first rescue analgesic. Results The onset of analgesia in Group I was recorded as 6.67±0.80 minutes, while Group II had an onset time of 7.67±0.80 minutes (p=0.001). The duration of analgesia for Group I was 5.16±0.72 hours, compared to 4.51±0.62 hours in Group II (p=0.001). The time until the first rescue analgesia was 5.260±0.716 hours for Group I, whereas Group II required 4.617±0.622 hours (p=0.001). Over a 24-hour period, Group I needed an average of 3.47±0.51 rescue doses, while Group II required 3.97±0.49 doses. The quality of analgesia was evaluated in both groups, showing no statistically significant differences. Adverse effects included nausea and vomiting in 4 patients and pruritus in 1 patient in Group I, while Group II experienced hypotension in 4 patients and bradycardia in 2 patients. Mean systolic and diastolic blood pressures were comparable across both groups, with significant differences only at 5, 10, and 15 minutes. The mean heart rates at 5, 10, and 15 minutes were 94.67±4.15, 89.73±3.85, and 85.40±4.40 in Group I, and 97.00±4.09, 92.20±3.46, and 87.53±3.27 in Group II, indicating statistical significance. The mean post-operative VAS scores recorded upto 24hrs. The mean VAS score was 0.40±0.498 and 0.47±0.507 at 2hrs, 2.87±0.730 and 2.93±0.691 at 4 hrs, 1.60±0.621 and 1.87±0.730 at 6hrs, 2.60±0.621 and 2.87±0.507 at 8hrs, 1.87±0.629 and 2.07±0.691 at 12hrs, 2.60±0.621 and 2.67±0.479 at 24hrs respectively. Conclusion Tramadol proved to be more effective than magnesium when combined with bupivacaine, as it led to a faster onset of pain relief, prolonged the duration of analgesia, and decreased the requirement for extra rescue epidural top-up doses within a 24-hour timeframe.

Early diagnosis of oral and systemic diseases remains a major challenge due to limitations in conventional invasive procedures. This review addresses the critical need for non-invasive, accessible diagnostics by examining the potential of saliva as an alternative diagnostic fluid. The main objective is to synthesize current knowledge on salivary biomarkers and technological innovations that enhance early detection capabilities. Methodologically, the review integrates evidence from proteomic, genomic, and metabolomic studies, as well as recent advances in microfluidic point-of-care devices. Key findings highlight that saliva contains a rich array of biomarkers, including cytokines, microRNAs, and extracellular vesicles, that can accurately reflect both local oral pathologies, such as dental caries and oral cancer, and systemic conditions, including diabetes, cardiovascular diseases, autoimmune disorders, and neurodegenerative diseases. The analysis further emphasizes that portable biosensors and lab-on-chip platforms are rapidly improving diagnostic sensitivity and enabling decentralized testing. Notwithstanding these encouraging advancements, issues with biological variability, standardization, and regulatory validation still exist. This review underscores the significance of interdisciplinary collaboration to overcome these barriers and fully integrate salivary diagnostics into routine healthcare. The implications are profound: widespread adoption could transform preventive medicine by providing patient-friendly, real-time monitoring tools that improve health outcomes globally.

Dyslipidemia is a major, yet under-recognized, driver of atherosclerotic cardiovascular disease (ASCVD) in Indian women. This expert consensus provides India-specific guidance on early detection, risk stratification, and management of lipid disorders across the female life course. Seventy-five specialists from cardiology, endocrinology, lipidology, obstetrics–gynecology, and primary care participated in a modified Delphi process with three structured rounds. An agreement threshold of ≥80% was maintained to develop statements based on 20 key clinical questions and a comprehensive review of international and Indian evidence. The consensus emphasizes early and repeated lipid screening. All women should have at least one lipid profile between ages 20 and 39 years, with earlier and more frequent testing in those with a family history of premature ASCVD, suspected familial hypercholesterolemia, polycystic ovary syndrome, gestational diabetes, pre-eclampsia, premature menopause, or autoimmune disorders. Life-stage checkpoints such as pre-conception, 6–12 weeks postpartum, and at menopause are highlighted as critical opportunities for evaluation and intervention. The panel developed India-specific, life-stage-oriented risk assessment and management statements for women, emphasizing early lipid screening, recognition of female-specific risk enhancers, and practical treatment pathways. Management begins with lifestyle optimization and, when indicated, stepwise pharmacotherapy: Statins as first line (avoiding routine use in pregnancy and lactation), ezetimibe or fibrates as add-on therapy, and PCSK9 inhibitors or Inclisiran for very-high-risk cases not at target. Bile-acid sequestrants are identified as the safest drug option during pregnancy or breastfeeding. This statement integrates global best practice with India-specific risk profiles and care pathways. By embedding life-stage-oriented screening, female-specific risk enhancers, and risk stratification into routine care, it provides a practical roadmap for clinicians and public health programs to reduce the burden of ASCVD in Indian women.

While copper oxide nanoparticles (CuO-NPs) have extensive applications in many sectors, their widespread use has increased the potential for environmental toxicity. This study aimed to determine the hepatic injury and oxidative stress induced by CuO nanoparticles (NPs) in male Wistar rats. They were orally administered CuO-NPs at concentrations of 50, 100 and 200 mg/Kg body weight (bwt), once daily for 28 days. A control group received ultrapure water. Twenty-four hours after completion of the experiment, samples were collected following established procedures. We analyzed several biomarkers and performed a histopathology assessment to evaluate liver damage. Our evaluation included measurements of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH) in serum samples, alongside an assessment of reduced glutathione (GSH) levels and microscopic examination of liver tissue morphology. The results of the study indicated that treated rats experienced increased levels of alanine aminotransferase (ALT), aspartate aminotransferase (AST), alkaline phosphatase (ALP) and lactate dehydrogenase (LDH), while experiencing a significant decrease in reduced glutathione (GSH), compared to the control group. Furthermore, histopathological examination of the liver in the treated rats revealed notable morphological alterations compared to the control group. Results from this investigation support the hypothesis that CuO-NP exert hepatotoxicity through the induction of oxidative stress.