European Journal of Cardiovascular Medicine

Background: Breast lesions comprise a heterogeneous group of inflammatory, benign, proliferative, and malignant disorders and represent one of the commonest causes of surgical consultation among women. Accurate preoperative diagnosis is essential for appropriate patient management. Fine-needle aspiration cytology (FNAC), together with clinical examination and radiological assessment, forms the cornerstone of the triple assessment approach. Despite advances in breast imaging and core needle biopsy, FNAC remains a rapid, minimally invasive, cost-effective, and reliable diagnostic modality, particularly in resource-limited healthcare settings. Objectives: To evaluate the diagnostic accuracy of fine-needle aspiration cytology in breast lesions and determine its correlation with Breast Imaging Reporting and Data System (BI-RADS) categorization and histopathological findings. Materials and Methods: A prospective observational study was conducted in the Department of Pathology, KM Medical College and Hospital, Mathura, Uttar Pradesh, India, after obtaining approval from the Institutional Ethics Committee (Approval No. KMU/RO/EECC/2023-24/52). The study was carried out over a two-year period from May 2024 to April 2026. A total of 200 consecutive patients presenting with palpable breast lesions underwent FNAC with clinicoradiological correlation. Histopathological examination was available in 110 cases and served as the reference standard for assessing the diagnostic performance of FNAC. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy were calculated. Results: Benign breast lesions constituted the majority of cases, with fibroadenoma being the most frequent diagnosis. Malignant lesions were more common in women aged over 40 years, with invasive ductal carcinoma representing the predominant malignant tumour. FNAC demonstrated excellent agreement with histopathological findings, showing a sensitivity of 93.8%, specificity of 95.7%, positive predictive value of 96.8%, negative predictive value of 91.7%, and an overall diagnostic accuracy of 94.5%. Increasing BI-RADS categories showed a statistically significant association with malignant cytological and histopathological diagnoses (p < 0.001).Conclusion: Fine-needle aspiration cytology is a highly reliable, minimally invasive, and cost-effective diagnostic technique for the evaluation of palpable breast lesions. Correlation with BI-RADS assessment and histopathological examination significantly improves diagnostic confidence and supports the continued role of the triple assessment approach in the diagnosis and management of breast diseases.

Background: Multi-system Inflammatory Syndrome in Children (MIS-C) is a post-infectious complication associated with COVID-19, characterized by hyperinflammation and multi-system involvement, particularly affecting the cardiovascular system. Early identification and evaluation of cardiac manifestations are essential to improve clinical outcomes. Objectives: To evaluate the demographic profile, clinical features, cardiovascular manifestations, and short-term outcomes in children diagnosed with MIS-C. Methods: This prospective cohort study was conducted at JJM Medical College, Karnataka, over six months (May–November 2021). A total of 59 children aged 0–18 years fulfilling WHO criteria for MIS-C were included. Clinical, laboratory, and echocardiographic parameters were recorded. Statistical analysis was performed using SPSS version 22.0, with p<0.05 considered significant. Results: The mean age was 8.14 years, with 38.9% in the 0–6 years group and a male predominance (61.0%). Fever was present in all patients (100%). Common symptoms included nausea/vomiting (54.2%), abdominal pain (44.0%), and rash (23.7%). Tachycardia and tachypnea were observed in 30.5% and 27% respectively. Cardiac evaluation showed normal left ventricular (LV) function in 71.1%, while 13.5% had mild and 3.3% had moderate dysfunction. Coronary abnormalities were noted, with LMCA aneurysm in 6.7% and LAD aneurysm in 6.7% of cases. Valvular lesions were predominantly mild, and coronary wall hyperechogenicity was observed in 42.4%. Most patients (67.7%) required hospitalization >14 days. The mean PICU stay was 2.94 days. The discharge rate was high (98.3%) with low mortality (1.6%). Conclusion: MIS-C is a multisystem disorder with significant but often reversible cardiovascular involvement. Early diagnosis, comprehensive cardiac evaluation, and timely management result in favorable outcomes, though prolonged hospitalization may be required.

Introduction: Early postoperative recovery assessment is essential following laparoscopic surgery performed under general anaesthesia to ensure patient safety and optimize post-anaesthesia care unit (PACU) utilization. The Modified Aldrete Score (MAS) is widely used for assessing physiological recovery, whereas the Fast Track Criteria (FTC) provide a more comprehensive evaluation by incorporating pain and postoperative emesis. This study compared the effectiveness of FTC and MAS in evaluating postoperative recovery. Aim: The aim of this study was to compare the Modified Aldrete Score with Fast-Track Criteria in the evaluation of post-operative recovery among patients undergoing laparoscopic surgical procedures under general anaesthesia. Methods: A comparative observational study was conducted over 18 months in the Department of Anaesthesiology, Sikkim Manipal Institute of Medical Sciences, involving 200 adult patients undergoing elective laparoscopic surgery. Patients were equally divided into the FTC (n=100) and MAS (n=100) groups. Baseline characteristics, perioperative haemodynamic parameters, recovery time, and postoperative recovery scores were compared using appropriate statistical methods. Results: Baseline demographic, clinical, and haemodynamic characteristics were comparable between the two groups (p>0.05). The duration of surgery was similar (91.4 ± 22.6 vs. 89.8 ± 21.9 minutes; p=0.612). Recovery time was significantly shorter in the MAS group (17.2 ± 17.8 vs. 21.9 ± 20.2 minutes; p<0.001). However, the FTC group demonstrated significantly higher recovery scores at all postoperative assessment intervals from 5 minutes to 12 hours (p<0.001).  Conclusion: The Fast Track Criteria provide a more comprehensive assessment of early postoperative recovery than the Modified Aldrete Score by evaluating physiological stability, pain, and functional recovery. FTC can be considered a reliable and practical tool for safe early recovery assessment and discharge planning following laparoscopic surgery under general anaesthesia.

Background: Testosterone deficiency is an increasingly recognised but under-investigated complication of type 2 diabetes mellitus (T2DM), arising from a bidirectional interplay between insulin resistance, visceral adiposity and suppression of the hypothalamic–pituitary–gonadal axis. Population-specific data on how closely testosterone tracks glycaemic control remain limited, particularly in Indian tertiary-care settings. We examined the association between serum total testosterone and glycaemic control, and assessed the impact of glycaemic status on testosterone, in men with T2DM. Methods: In this single-centre, hospital-based cross-sectional study, 150 men aged above 18 years with T2DM were enrolled by simple random sampling from outpatient and inpatient services. Fasting serum total testosterone, HbA1c, fasting blood glucose, lipid profile and anthropometric measures were assessed. Associations were tested using Pearson correlation, one-way ANOVA, the independent-samples t test and the chi-square test, with p < 0.05 considered significant. Results: Mean age was 53.1 ± 13.3 years, mean HbA1c 8.31 ± 1.22%, and mean serum total testosterone 421.3 ± 212.1 ng/dL; hypogonadism was present in 47.3% of participants. Serum testosterone correlated inversely with HbA1c (r = −0.53, 95% CI −0.63 to −0.40; p < 0.0001), independent of age, body mass index, diabetes duration and total cholesterol. Testosterone declined stepwise across worsening glycaemic strata, from 599.3 ng/dL in optimal control to 285.9 ng/dL in very poor control (ANOVA F = 22.49, p < 0.0001), with hypogonadism prevalence rising from 18.8% to 78.6%. Hypogonadal men had significantly higher HbA1c and fasting glucose than eugonadal men (both p < 0.0001), and hypogonadism was strongly associated with glycaemic-control category (χ² = 30.67, p < 0.0001). Conclusions: Lower serum testosterone is robustly and independently associated with poorer glycaemic control in men with T2DM, with hypogonadism concentrated among the most poorly controlled patients. These findings support routine androgen screening in diabetic men with suboptimal glycaemic control.

Background: Cervical cancer remains a leading cause of morbidity and mortality among women worldwide, particularly in resource-limited settings lacking organized screening programmes. Papanicolaou (Pap) smear cytology has long served as a simple, minimally invasive tool for early detection of premalignant and malignant cervical lesions, prompting evaluation of its effectiveness in mass screening.Objective: To determine the effectiveness of Pap smear in mass screening for cervical lesions.Materials and Methods: This hospital-based, observational, prospective study was conducted in the Departments of Pathology and Obstetrics & Gynaecology, F.H. Medical College, Tundla, Firozabad, Uttar Pradesh, India, over 18 months. A total of 250 women attending outpatient gynaecology services were enrolled by consecutive sampling. Data were analyzed using SPSS v25, with Chi-square and t-tests; significance was set at p<0.05.Results: Among 250 participants, the majority (32.0%) belonged to the 41–50 years age group. Pap smear showed normal cytology in 64.0% and inflammatory changes in 16.0%; the remainder showed abnormal findings, including low-grade and high-grade squamous intraepithelial lesions (LSIL, HSIL) and squamous cell carcinoma. Pap smear correlated significantly with biopsy results (p<0.001). Biopsy positivity was higher when indicated by abnormal Pap smear than by clinical suspicion (78/155 vs. 27/95; p=0.02), and Pap smear identified more positive cases overall (36.0%) than clinical suspicion (10.8%). Sensitivity was 93.3%, specificity 96.0%.Conclusion: Pap smear demonstrated high diagnostic accuracy and a strong correlation with biopsy findings, identifying more cervical lesions than clinical suspicion alone. These findings support Pap smear as an effective, reliable tool for mass cervical cancer screening, particularly in resource-limited settings

Background: Adolescent overweight and obesity have become major public health concerns worldwide due to their increasing prevalence and association with chronic non-communicable diseases in adulthood. India is experiencing a rapid nutritional transition characterized by unhealthy dietary habits, physical inactivity, and increasing sedentary lifestyles, contributing to a rising burden of obesity among adolescents. Limited data are available from Himachal Pradesh regarding the prevalence and determinants of adolescent overweight and exogenous obesity. Objective: To determine the prevalence of overweight and exogenous obesity and identify the associated demographic, familial, socioeconomic, and lifestyle determinants among adolescents attending a tertiary care hospital in Himachal Pradesh. Materials and Methods: A hospital-based cross-sectional observational study was conducted among 400 adolescents aged 10–18 years attending the outpatient and inpatient departments of Pediatrics at Shri Lal Bahadur Shastri Government Medical College and Hospital, Nerchowk, Himachal Pradesh, between June 2024 and June 2025. Associations between potential risk factors and overweight/obesity were evaluated using univariate analysis and multivariable logistic regression. Results: Among the 400 adolescents, 13.8% were overweight and 10.5% were obese, resulting in a combined prevalence of 24.3%, while 72.8% had normal BMI and 3.0% were underweight. Multivariable logistic regression identified maternal obesity (AOR = 2.49, p = 0.007), paternal obesity (AOR = 2.08, p = 0.018), frequent junk food consumption (AOR = 2.56, p = 0.001), physical inactivity (AOR = 2.23, p = 0.004), prolonged screen time (AOR = 1.91, p = 0.017), and frequent consumption of sugar-sweetened beverages (AOR = 1.82, p = 0.031) as significant independent determinants of overweight and obesity. Conclusion: Nearly one-fourth of adolescents attending the tertiary care hospital were either overweight or obese, indicating a substantial and emerging public health challenge. Family history of obesity and modifiable lifestyle behaviours were significant determinants of excess body weight.

Background: Magnetic Resonance Spectroscopy (MRS) is an advanced neuroimaging modality that provides metabolic information beyond conventional MRI. Brain tumours exhibit characteristic biochemical alterations that can aid in tumour characterization, differentiation, and prognostic assessment. This study was conducted to evaluate the role of MRS in identifying distinct metabolic patterns among various brain tumour types and to correlate these findings with tumour grade and histopathology. Aim: To evaluate the diagnostic and prognostic utility of Magnetic Resonance Spectroscopy (MRS) in the characterization and differentiation of brain tumours based on metabolite profiles, with validation against histopathological findings. Methods: This hospital-based cross-sectional observational study included 68 patients with histopathologically confirmed brain tumours. Proton MR Spectroscopy was performed, and metabolite ratios including Choline/N-acetyl aspartate (Cho/NAA), Choline/Creatine (Cho/Cr), and NAA/Cr were analysed. The presence of lipid–lactate peaks was also assessed. Statistical analysis was performed using SPSS software, and intergroup comparisons were made using ANOVA, with a p-value of <0.05 considered statistically significant. Diagnostic performance was evaluated using sensitivity and specificity analysis. Results: MRS demonstrated distinct metabolic patterns across tumour categories. High-grade gliomas showed significantly elevated Cho/NAA (mean 3.15 ± 0.78) and Cho/Cr (2.92 ± 0.63) ratios with reduced NAA/Cr (0.42 ± 0.18), whereas low-grade gliomas demonstrated lower Cho/NAA (1.32 ± 0.28), lower Cho/Cr (1.41 ± 0.31), and relatively preserved NAA/Cr (1.18 ± 0.27). These differences were statistically significant (p < 0.001). Metastatic tumours showed moderately elevated Cho/NAA (2.23 ± 0.68) and frequent lipid–lactate peaks, Lipid–lactate peaks were strongly associated with high-grade and metastatic tumours. Meningiomas demonstrated markedly high Cho/NAA (5.04 ± 1.18) with near absence of NAA.  Using combined spectroscopic criteria, MRS demonstrated a sensitivity of 91.2% and specificity of 79.4% in differentiating high-grade from low-grade/benign tumours, demonstrating good diagnostic accuracy. Conclusion: MR Spectroscopy reliably differentiates tumour types based on distinct metabolic signatures and demonstrates significant correlation with tumour grade and histopathological findings. Elevated Cho/NAA and Cho/Cr ratios, along with lipid–lactate peaks, are associated with aggressive tumour biology, whereas preserved NAA/Cr ratios correlate with lower-grade pathology. MRS serves as a valuable non-invasive adjunct to conventional MRI in preoperative tumour characterization and risk stratification. Further studies with larger sample sizes are recommended to refine metabolite cut-off values and strengthen prognostic applications.

INTRODUCTION: Adolescence is a crucial period in human growth and development. Menarche is an important biological milestone in a woman’s life, marking the onset of the reproductive phase. Poor menstrual hygiene practices may lead to various morbid conditions such as reproductive tract infections, urinary tract infections, infertility, miscarriages, toxic shock syndrome, and cancer. OBJECTIVES: To assess and compare the menstrual problems among school-going adolescent girls and reproductive health morbidities among adolescent girls and boys in urban and rural areas of South India. METHODOLOGY: A school-based cross-sectional study was conducted among 416 adolescent girls and boys aged 10–19 years residing in the urban and rural field practice areas of Kurnool Medical College. Data were collected between March 2023 and March 2025 using a semi-structured questionnaire through a simple random sampling technique. Institutional Ethics Committee (IEC) permission was obtained, and written informed consent was secured from the participants. Data were analyzed using SPSS Version 23. RESULTS: The majority of adolescents belonged to the 10–15 years age group in both urban (76.92%) and rural areas (79.32%). Most adolescent girls attained menarche between 10–12 years in both urban (46.15%) and rural areas (64.42%). A menstrual cycle duration of 21–30 days was reported by 74.03% of adolescent girls in urban areas and 71.15% in rural areas. The prevalence of dysmenorrhea was higher in urban areas compared to rural areas. The most common symptom experienced during menstruation among adolescent girls was tiredness in both urban and rural areas. The most common symptom of reproductive tract problems among adolescents was itching in the genital area in both urban and rural areas. CONCLUSION: The prevalence of dysmenorrhea was higher among adolescent girls in urban areas compared to rural areas. Tiredness was the most commonly reported symptom during menstruation in both settings. Itching in the genital area was the most common reproductive tract problem reported among adolescents in both urban and rural areas.