European Journal of Cardiovascular Medicine

Background: Compared to their older counterparts, people under 40 are less likely to develop acute coronary syndromes (ACS) due to traditional cardiovascular (CV)-risk factors. Aim : The purpose of this study is to determine how common essential thrombocytosis (ET), a hematological condition and less common risk factor, is in young patients who report with ACS. Methodology : We created a retrospective database of all patients under 40 (n=180) who had known thrombocyte counts (n=180 ) and had undergone subsequent coronary angiography (CAG) following their initial ACS at our institution throughout the previous five years (2021-2026). This haematological condition was screened for in patients with thrombocytes greater than 450x10*9/L. Results: We found 10 individuals with thrombocytosis in our database. One was formerly referred to as ET. Of the 10 patients who remained, four were diagnosed with reactive/secondary thrombocytosis, two were lost to follow-up, four received an ET diagnosis, and one is still unknown.  Conclusion : ET seems to be prevalent in patients under 40 with ACS, with an incidence of at least 2%. Additionally, 27% of patients with ACS and increased thrombocytes had a fresh diagnosis of ET after screening. In every instance, the diagnosis was originally overlooked. Cardiologists should be aware of, identify, and screen for this pathology in ACS patients, especially in those who do not have traditional CV-risk factors. An "ACS-protocol" targeted at less common risk factors could support this, since the timing of revascularization should be adjusted to thrombocyte count/initiation of ET therapy to prevent thrombotic complications.

Background: Diabetes mellitus introduces unique pathophysiological alterations in connective tissue and joint mobility that may predispose elderly patients to difficult airway management. Despite this, comparative data on the performance of specific bedside airway assessment tools in elderly diabetic versus non-diabetic populations remains limited.Aims and Objectives: This study aimed to evaluate and compare the diagnostic accuracy of the Upper Lip Bite Test (ULBT), Modified Mallampati Score (MMS), Palm Print Sign (PPS), and neck range of movement in predicting difficult laryngoscopy among elderly diabetic and non-diabetic patients undergoing elective surgery under general anaesthesia.Methods: A cross-sectional interventional comparative study was conducted at R.L. Jalappa Hospital and Research Centre, Kolar, from May 2023 to March 2025. A total of 184 patients aged ≥60 years were enrolled — 92 diabetic and 92 non-diabetic. Preoperative airway assessment was performed using ULBT, MMS, PPS, and neck range of movement. Intraoperative laryngoscopic view was graded using the Cormack-Lehane (CL) system. Number of intubation attempts, time to intubation, and need for alternative methods were recorded. Sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for each test.Results: Difficult laryngoscopy (CL Grade III–IV) was significantly more frequent in diabetic patients (34.8% vs. 17.6%, p=0.010). Class III ULBT was found in 38.0% of diabetic patients versus 4.3% of non-diabetic patients (p<0.001). Difficult Palm Print Sign grades were more prevalent in diabetic patients (26.1% vs. 7.6%, p=0.001). Prolonged intubation time occurred in 10.9% of diabetic patients compared to 3.3% of non-diabetic patients (p=0.048). In diabetic patients, ULBT demonstrated the highest sensitivity (90.6%) and specificity (90.0%), followed by MMS (sensitivity 75.0%, specificity 100%) and PPS (sensitivity 65.6%, specificity 95.0%). In non-diabetic patients, MMS showed the highest sensitivity (75.0%), while ULBT and PPS had excellent specificity.Conclusion: Elderly diabetic patients carry a significantly higher risk of difficult laryngoscopy. The Upper Lip Bite Test is the most sensitive predictor in this group, while Modified Mallampati Score performs better in non-diabetic patients. Comprehensive multi-test preoperative airway assessment is strongly recommended for elderly diabetic patients

Introduction: Breast lesions represent a frequent clinical presentation and encompass a wide spectrum ranging from benign inflammatory and proliferative conditions to malignant tumors. Early and accurate diagnosis is essential for optimal management and improved outcomes. Fine-needle aspiration cytology (FNAC) is widely used as a rapid, minimally invasive, and cost-effective diagnostic technique. The IAC Yokohama System standardizes breast cytology reporting into defined categories with associated risk of malignancy. Methods: This retrospective observational study was conducted in the Department of Pathology, ESIC Medical College and Hospital, Namkum, Ranchi. A total of 118 patients with palpable breast lesions who underwent FNAC from January 2024 to June 2026 were included. FNAC was performed using 22–23 gauge needles under aseptic conditions, with ultrasound guidance in selected cases. Smears were prepared and stained using Giemsa, Papanicolaou, and Hematoxylin and Eosin stains. Cytomorphological assessment was carried out and classified according to the IAC Yokohama System. Results: Among 118 cases, females predominated (94.9%). The most affected age group was 20–29 years (54.2%). Right breast lesions were more common (55.9%) compared to left-sided and bilateral involvement. Cytological evaluation revealed a predominance of benign lesions (C2, 87.3%), with fibroadenoma being the most frequent diagnosis (59.3%). Malignant lesions (C5) accounted for 6.8% of cases, all of which were invasive ductal carcinoma. Benign lesions were mainly seen in younger patients, whereas malignant cases were predominantly observed in those above 40 years of age. Conclusion: FNAC remains a reliable and effective first-line diagnostic tool for breast lesions. The IAC Yokohama System provides a standardized reporting format that enhances diagnostic accuracy and clinical communication. Most breast lesions are benign; however, the likelihood of malignancy increases with age, emphasizing the importance of timely cytological evaluation.

Introduction: Early risk stratification in patients with acute ST-elevation myocardial infarction (STEMI) is essential for identifying individuals at increased risk of adverse in-hospital outcomes. N-terminal pro-B-type natriuretic peptide (NT-proBNP), a biomarker of myocardial wall stress, has shown prognostic value following acute coronary events; however, locally validated data from Bangladesh remain limited. Aim of the Study: To evaluate the prognostic significance of admission NT-proBNP levels in predicting adverse in-hospital outcomes among patients with acute STEMI. Methods: This prospective observational analytical study was conducted among 92 patients with acute ST-segment elevation myocardial infarction (STEMI) admitted to the Department of Cardiology, National Heart Foundation Hospital and Research Institute, Dhaka, Bangladesh, between May 2017 and April 2018. Plasma NT-proBNP levels were measured on admission before echocardiographic evaluation, and patients were categorized into normal (100–900 pg/mL) and elevated (>900 pg/mL) NT-proBNP groups. Clinical characteristics, laboratory findings, echocardiographic parameters, and adverse in-hospital outcomes were compared between the groups. Receiver operating characteristic (ROC) curve analysis was performed to assess the prognostic performance of NT-proBNP in predicting adverse in-hospital outcomes. Results: The mean age of the study population was 53.66 ± 11.63 years, and 85.9% were male. Elevated NT-proBNP (>900 pg/mL) was present in 39 (42.4%) patients, while high left atrial volume index (LAVI >34 mL/m²) was observed in 48 (52.2%). Mean NT-proBNP levels were significantly higher in patients with increased LAVI than in those with normal LAVI (1234.6 ± 738.8 vs. 689.5 ± 721.0 pg/mL; p=0.001). Adverse in-hospital outcomes occurred significantly more frequently in patients with elevated NT-proBNP than in those with normal levels (89.7% vs. 62.3%; p=0.003). ROC analysis identified 900 pg/mL as the optimal cut-off, with 50.0% sensitivity, 83.3% specificity, and an area under the curve of 0.631 (95% CI: 0.511–0.751; p=0.057). Conclusion: Elevated admission NT-proBNP is significantly associated with adverse in-hospital outcomes in patients with acute STEMI. Although its discriminatory performance was modest, NT-proBNP is a useful and readily available biomarker for early risk stratification and may improve prognostic assessment when combined with other clinical or echocardiographic parameters.

Thymomas are rare epithelial tumors that typically develop in the anterior mediastinum and frequently manifest alongside myasthenia gravis. During embryological development, aberrant thymic migration can leave ectopic tissue rests that rarely undergo neoplastic transformation. While ectopic thymomas occur in various unusual sites, a paravertebral presentation is exceptionally rare and often mimics neurogenic or paraspinal tumors on imaging. This report presents a rare case of a Type B2 ectopic thymoma presenting as a right paravertebral extrapleural mass. This case highlights the significant diagnostic challenges these tumors pose and emphasizes the importance of including ectopic thymoma in the differential diagnosis of atypical paravertebral lesions