Current Clinical and Medical Education

Decoding Thyroid Lesions – A Correlative Study Between Cytology and Radiological Findings

2026-07-15T06:02:11+00:00

Background: Thyroid nodules are among the most frequently encountered endocrine lesions, with the majority being benign while a small but significant proportion harbor malignancy. Accurate preoperative risk stratification is essential to avoid unnecessary surgical intervention and ensure timely management of malignant lesions. Fine-needle aspiration cytology (FNAC) and ultrasonography are widely used diagnostic tools, and their combined application may enhance diagnostic accuracy.

Objectives: To correlate cytological findings categorized according to the Bethesda System for Reporting Thyroid Cytopathology with ultrasonographic findings classified using the ACR TI-RADS system and to evaluate their diagnostic performance against histopathological examination.

Materials and Methods: This cross-sectional observational study included 261 patients with thyroid lesions who underwent FNAC, ultrasonographic evaluation, and subsequent surgical excision between January 2023 and December 2024. Cytological diagnoses were reported according to the Bethesda System, while ultrasonographic findings were categorized using ACR TI-RADS. Histopathological examination served as the gold standard. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic accuracy, and agreement between modalities were assessed.

Results: Of the 261 patients studied, females constituted 80.1% of cases, with the highest frequency observed in the 21–40-year age group. Bethesda category II lesions were the most common cytological diagnosis (67.4%), while TI-RADS category TR3 represented the largest radiological group (30.3%). FNAC demonstrated a sensitivity of 86.0%, specificity of 91.5%, and diagnostic accuracy of 89.3%. Ultrasonography showed a sensitivity of 82.4%, specificity of 88.7%, and accuracy of 86.2%. The combined use of FNAC and TI-RADS significantly improved diagnostic performance, achieving a sensitivity of 92.9%, specificity of 94.1%, and overall accuracy of 93.4%. Discordant findings were predominantly encountered in indeterminate cytological categories.

Conclusion: Integration of Bethesda-based cytological reporting with ACR TI-RADS risk stratification substantially improves the preoperative evaluation of thyroid nodules. The combined approach enhances diagnostic accuracy, facilitates more effective risk stratification, and supports informed clinical decision-making, thereby reducing unnecessary surgical procedures while ensuring appropriate management of malignant thyroid lesions.

Comparative Effects of Saroglitazar, Vitamin E and Lifestyle Modification on Liver Fibrosis Markers in Metabolic Dysfunction-Associated Steatotic Liver Disease

2026-07-15T06:16:51+00:00

Introduction: This study presents the effects of metabolic dysfunction-associated steatotic liver disease (MASLD), which is a global health issue. It is related with obesity, metabolic dysfunction, and progressive liver fibrosis. In order to prevent this issue, it requires an effective treatment plan. This study assessed the effect of Saroglitazar, Vitamin E, and lifestyle modification on liver fibrosis markers and metabolic parameters in patients with MASLD/metabolic dysfunction-associated steatohepatitis (MASH).

Methods: This investigator-initiated, prospective, randomised study was conducted among 170 patients from May 2025 to April 2026 in our hospital. 170 participants were divided into three groups: Saroglitazar (n=60), Vitamin E (n=60), and Only Lifestyle group (n=50). Each parameter was measured at baseline and after 24 weeks.

Results: Baseline characteristics were comparable across the Saroglitazar (n=60), Vitamin E (n=60), and Lifestyle (n=50) groups. Median age (33–35 years; p=0.72), male distribution (86–88%; p=0.91), anthropometric measures, and all baseline laboratory parameters showed no significant differences (all p>0.05). After 24 weeks, improvements were observed across all groups, with significant between-group differences only for triglyceride reduction, which was greatest with Saroglitazar (−14.2 vs. −4.5 vs. −13.5 mg/dL; p=0.034). The proportion achieving ≥2 kPa liver stiffness reduction was highest with Saroglitazar (40%), followed by Vitamin E (35%) and Lifestyle intervention (20%), with Saroglitazar significantly outperforming Lifestyle intervention (p=0.028).

Conclusion: The study concluded that the Saroglitazar showed improvement in the triglyceride levels and liver stiffness response, while all other three interventions showed similar improvement in the fibrosis and the functional marker for liver.

Pattern and Prevalence of Acute and Delayed Transfusion Reactions Following Blood Component Therapy

2026-07-15T06:31:11+00:00

Introduction: The blood transfusion procedure is crucial from a therapeutic standpoint but may cause adverse effects to the patients through acute and delayed adverse transfusion reactions (ATRs). It is therefore crucial to maintain constant hemovigilance in order to reduce such occurrences. The objective of this study was to determine the frequency, type, and presentation of these ATRs.

Methods: The study is based on observations made by the researchers in the Department of Transfusion Medicine, L.N. Medical College and Research Center, Indore during the period from July 2025 to March 2026. Information from 160 transfused patients and 520 blood component units is used in the study. Transfusion reactions are classified clinically and biochemically and described.

Results: Of 160 patients who had adverse transfusion reactions, adult patients represented 78.7% and female patients 56.2%. Of 520 units of blood components transfused, packed red blood cells were the highest in percentage (36.5%), and they were responsible for 68.0% of all the reactions. Febrile non-hemolytic transfusion reaction accounted for 40.0% of all the reactions, and allergic reactions 36.0%. Fever accounted for 28.0%, and itching 24.0% of all the reaction.

Conclusion: The study concluded low incidence of mild adverse transfusion reactions, along with FNHTRs and allergic reactions as the most common associated with the PRBC transfusions.

Seroprevalence of Transfusion Transmitted Infections in Blood Donors and Analysis of Response to Subsequent Counselling Using the SPIKES Protocol: A Five-Year Retrospective Study

2026-07-27T14:25:35+00:00

Background

Transfusion-transmitted infections (TTIs) remain a significant challenge to blood safety despite advances in donor screening. Timely notification and counselling of seroreactive donors are essential to prevent secondary transmission and ensure appropriate medical care. The SPIKES protocol, originally developed for breaking bad news in oncology, has recently been adapted for counselling seroreactive blood donors.

Objectives

To determine the seroprevalence of TTIs among blood donors and evaluate donor response to post-donation notification and counselling using the SPIKES protocol.

Materials and Methods

A retrospective cross-sectional study was conducted at a tertiary care blood centre over five years (June 2016–May 2021). 18,750 blood donations took place in given time period. All donations were screened for HIV, hepatitis B virus (HBV), hepatitis C virus (HCV), syphilis, and malaria according to national guidelines. Seroreactive donors were contacted through telephone and postal communication, followed by counselling using the SPIKES protocol.

Results

Among 18,750 donors, 18,240 (97.3%) were males and 510 (2.7%) were females. Overall seroreactivity was 1.31% (246 donors). HBV was the most common TTI (0.73%), followed by HCV (0.29%), syphilis (0.16%), HIV (0.11%), and malaria (0.02%). Of the 246 seroreactive donors, 189 (76.8%) responded to the first telephone call, 28 (11.4%) after the second call, and 10 (4.1%) after postal notification. Nineteen donors (7.7%) could not be contacted. Overall counselling success was 92.3%. A statistically significant association was observed between voluntary donation and counselling compliance (p=0.03).

Conclusion

HBV constituted the predominant hypothetical TTI among blood donors. Structured communication using the SPIKES protocol demonstrated high counselling compliance and may improve donor acceptance, follow-up, and referral.

Community Acceptance of Indoor Residual Spraying for Malaria Control and Associated Factors

2026-08-08T07:17:44+00:00

Introduction: Malaria remains a major global public health challenge despite substantial progress in control measures. In 2024, an estimated 282 million cases and 610,000 deaths were reported, with nearly 95% occurring in the WHO African Region. In India, malaria burden has declined considerably, although transmission persists in endemic regions. Indoor Residual Spraying (IRS) is an effective WHO-recommended intervention; however, its success depends largely on community acceptance, awareness, and participation.

Method: A community-based cross-sectional analytical study was conducted among 220 randomly selected adult household representatives from malaria-endemic rural villages of Palghar district, Maharashtra (2024–2025). Data were collected using a validated, interviewer-administered questionnaire assessing socio-demographic characteristics, housing conditions, malaria knowledge, perceptions, receipt of IEC messages, and acceptance of Indoor Residual Spraying (IRS). Associations were examined using Chi-square tests and logistic regression to estimate crude and adjusted odds ratios with 95% confidence intervals, considering p<0.05 statistically significant.

Result: The study found 56 (25.5%) households accepted IRS, whereas 164 (74.5%) refused. Acceptance was significantly higher among nuclear families (28.5% vs. 16.4%; p=0.004), residents of kuccha/semi-pucca houses (47.1% vs. 21.5%; p=0.001), lower socioeconomic groups (26.9% vs. 20.8%; p=0.042), and participants receiving malaria IEC messages (30.6% vs. 18.8%; p=0.031). Multivariable analysis identified kuccha/semi-pucca housing (AOR=3.86) and receipt of IEC messages (AOR=2.16) as the strongest independent predictors of IRS acceptance.

Conclusion: The study concluded that acceptance to IRS was very low, with 25.5% of the respondents accepting IRS and 74.5% refusing the intervention.

Assessment of Insulin Resistance and Pancreatic β-Cell Function Using Homeostatic Model Assessment Indices in Asian Indian Patients with Type 2 Diabetes Mellitus: A Case-Control Study

2026-08-08T07:23:50+00:00

Type 2 diabetes mellitus (T2DM) is characterised by the dual pathophysiological abnormalities of insulin resistance and progressive pancreatic β-cell dysfunction. Asian Indians exhibit a distinctive metabolic phenotype characterised by increased central adiposity and heightened insulin resistance at lower body mass index (BMI) values compared with Western populations, contributing to disproportionately high susceptibility to T2DM. The Homeostatic Model Assessment (HOMA) provides a simple and validated method for quantifying insulin resistance (HOMA-IR) and β-cell secretory capacity (HOMA-β) from fasting glucose and insulin concentrations. The present hospital-based case-control study included 40 patients with T2DM and 40 age- and sex-matched non-diabetic controls recruited from a tertiary care centre in North India. Anthropometric measurements and biochemical parameters including fasting plasma glucose, fasting serum insulin, glycated haemoglobin (HbA1c), HOMA-IR, and HOMA-β were assessed and compared between groups. Diabetic subjects demonstrated significantly higher waist circumference (89.18±7.28 vs 81.50±8.34 cm, p=0.001), fasting plasma glucose (173.86±69.85 vs 92.56±16.80 mg/dL, p<0.001), fasting insulin (12.35±8.98 vs 7.33±4.98 mU/L, p=0.01), HbA1c (8.05±1.43 vs 5.12±0.55%, p=0.003), and HOMA-IR (5.20±3.87 vs 1.70±1.22, p=0.001) compared with non-diabetic controls. HOMA-β was significantly lower in diabetic subjects (53.36±51.34 vs 115.34±101.40, p=0.003), indicating impaired β-cell secretory function. BMI was higher in diabetic subjects, achieving borderline significance (25.28±4.14 vs 23.37±3.52 kg/m², p=0.05). These findings confirm the dual contribution of insulin resistance and β-cell dysfunction to T2DM pathogenesis in Asian Indians and support the utility of HOMA indices as practical, cost-effective tools for metabolic risk assessment in clinical and epidemiological settings.

Correlation of Clinical, Magnetic Resonance Imaging, and Intraoperative Findings in the Preoperative Assessment of Fistula-in-Ano: A Prospective Observational Study

2026-08-08T08:16:39+00:00

Background: Accurate preoperative delineation of the fistulous tract, internal opening, and any secondary extensions is essential for successful surgical management of fistula-in-ano, since incomplete identification is a major cause of persistence and recurrence. Magnetic resonance imaging (MRI) has increasingly been adopted as the preoperative imaging modality of choice, but its diagnostic performance must be validated against intraoperative findings in the population in which it is used.

Objective: To assess and correlate clinical examination, MRI, and intraoperative findings in patients with fistula-in-ano, and to determine the diagnostic accuracy of MRI, using intraoperative findings as the reference standard, for the internal opening, tract complexity, secondary tracts, abscess, horseshoe extension, and supralevator extension.

Methods: This prospective observational study enrolled 30 adults with a clinical diagnosis of fistula-in-ano at a tertiary-care teaching hospital over an 18-month period. All patients underwent digital rectal examination and proctoscopy, followed by pelvic MRI (1.0 Tesla, phased-array coil; T1 and T2-weighted turbo spin-echo sequences in axial, coronal, and optional sagittal-oblique planes) prior to surgery. Fistulas were classified using both the Parks classification and the St. James's University Hospital MRI-based grading system. All patients subsequently underwent examination under anesthesia and definitive surgery (fistulotomy or fistulectomy, with seton placement for high tracts), which served as the diagnostic reference standard. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of MRI were calculated for each finding.

Results: The cohort comprised 26 men and 4 women (mean age 35.6 years; most common age group 31–40 years). All patients had a palpable external opening on examination, most frequently at the 3 o'clock position (20%), while the internal opening was clinically palpable in only 4 of 30 patients (13.3%). MRI identified the internal opening in all 30 patients (100%), most commonly at the 6 o'clock position (26.7%). By Parks classification, intersphincteric fistulas predominated (63.3%), followed by transsphincteric (26.7%), suprasphincteric (6.7%), and extrasphincteric (3.3%) tracts. Intraoperatively, simple tracts were confirmed in 17 patients (56.7%) and complex tracts in 13 (43.3%); of the complex tracts, abscess was present in 5 (38.5%), secondary tracts in 4 (30.8%), horseshoe extension in 3 (23.1%), and supralevator extension in 1 (7.7%). Overall MRI–surgical concordance was 86.7% (26/30). MRI showed a sensitivity/specificity/PPV/NPV of 100%/84.6%/89.4%/100% for simple tracts, 100%/89.5%/100%/84.6% for complex tracts, 75%/88.8%/75%/88.9% for secondary tracts, 80%/100%/100%/88.8% for abscess, and 33.3%/90%/50%/81.8% for horseshoe extension.

Conclusion: MRI is a highly accurate, noninvasive preoperative tool for delineating fistula anatomy and shows excellent diagnostic performance for the internal opening, tract complexity, and abscess, but more limited sensitivity for horseshoe extension in this cohort. Intraoperative findings remain the diagnostic reference standard, and MRI is best used as a complementary road map that informs, rather than replaces, careful intraoperative assessment.

Maternal Serum Ferritin Concentrations in Pregnancies Complicated by Preterm Labour or Preterm Prelabour Rupture of Membranes: A Comparative Observational Study

2026-08-14T18:12:00+00:00

Background: Ferritin reflects both iron stores and acute-phase inflammation. Its concentration may differ in pregnancies complicated by spontaneous preterm labour or preterm prelabour rupture of membranes (PPROM), but contemporaneous measurement after clinical presentation cannot establish prediction.

Objective: To compare maternal serum ferritin concentrations among women with PPROM, spontaneous preterm labour, and uncomplicated pregnancies at 28–36+6 weeks of gestation, and to describe associated maternal laboratory findings and perinatal outcomes.

Methods: This hospital-based comparative observational study enrolled 210 pregnant women at a tertiary centre in Central India from June 2024 to January 2026: 70 with PPROM, 70 with spontaneous preterm labour, and 70 controls. Serum ferritin was measured by immunoturbidimetry. Continuous outcomes were compared using Welch's one-way analysis of variance with Games–Howell pairwise tests; categorical variables were compared using Pearson's chi-square test.

Results: Mean (SD) ferritin was 20.89 (10.10) ng/mL in controls, 59.39 (40.30) ng/mL in PPROM, and 41.23 (25.20) ng/mL in preterm labour (Welch F(2, 109.01)=45.40; p<0.001). Compared with controls, the mean difference was 38.50 ng/mL for PPROM (95% CI, 26.63–50.37) and 20.34 ng/mL for preterm labour (95% CI, 12.61–28.07); PPROM also exceeded preterm labour by 18.16 ng/mL (95% CI, 4.67–31.65). Leukocyte counts were higher and haemoglobin was lower in both complication groups, whereas C-reactive protein positivity did not differ. Gestational age at sampling and documented vaginitis/urinary tract infection also differed substantially among groups. Infants in the PPROM and preterm-labour groups delivered earlier, weighed less, and were more often admitted to neonatal intensive care.

Conclusions: Maternal ferritin was higher at presentation with PPROM or spontaneous preterm labour than in controls. Because ferritin was measured after diagnosis and the groups differed in gestational age and infection status, these data support ferritin as a concurrent inflammatory correlate, not as a validated independent screening or predictive test. Prospective studies with prespecified sampling, multivariable adjustment, and external validation are required.