Medical Science: Updates and Prospects Vol. 3

Pentraxin 3: A Multifaceted Mediator of Inflammation and Cardiovascular Risk

2025-12-27T07:34:22+00:00

Introduction: Pentraxin 3 (PTX3) is an acute-phase protein that stands at the intersection between inflammation and cardiovascular pathology. Influential role of PTX3 impacts vascular inflammation, endothelial function and atherosclerotic progression. Pentraxin vascular health is staged by its dual role as a biochemical marker and a potential modulator that provides greater specificity than systemic C-reactive protein. Data synthesised positions pentraxin as a promising candidate for precision cardiovascular medicine. PTX3 is a long pentraxin produced by stromal and myeloid cells in response to inflammatory signals and microbial moieties. It plays a multifunctional role in inflammation, acting as a functional ancestor of antibodies.

Objective: This review explores the relationship between PTX3 and cardiovascular risk, its diagnostic and prognostic value, and its implications for clinical practice. The objectives focused on in this chapter are the functional role of PTX3 to stratify patients according to the severity of cardiovascular risk. Secondly, the prognostic role of elevated PTX3 levels speaks about the worst outcome in patients with cardiovascular disease. Thirdly, PTX3 can be considered as a therapeutic target that reinforces new avenues of treatment.

Methodology: This book chapter is an outcome of a comprehensive literature review that focused on articles from the PubMed database, Scopus and Web of Science databases. Utilised the keywords such as pentraxin 3, cardiovascular disease, atherosclerosis, and inflammation. Through a reductionist approach, mechanistic insights with regard to the association between pentraxin and cardiovascular health were framed.

Conclusion: PTX3 is a promising biomarker for cardiovascular risk assessment and disease progression. Further research is needed to establish standardised reference values and explore its potential as a therapeutic target.

Ovarian Mass Leading to the Diagnosis of Krukenberg Tumour: A Case Report

2025-12-27T07:37:23+00:00

A Krukenberg tumour is a distinct metastatic ovarian carcinoma, a secondary ovarian malignancy arising from a distant primary site. They often show nonspecific gastrointestinal symptoms, which lead to a delayed diagnosis and a poor prognosis.

This case report exemplifies the challenges associated with diagnostic delays of Krukenberg tumours, especially in distinguishing metastatic ovarian tumours from primary ovarian cancer, and the limited treatment options available in the advanced stages of the disease, which can affect patients' prognosis.

Histopathological analysis revealed diffusely invasive growing cancerous tissue with granular and diffuse single distribution in which numerous tumour cells had a signet–ring appearance indicative of a Krukenberg tumour from the stomach. Despite postoperative recovery and subsequent admission for treatment, the patient encountered recurrent obstruction and ultimately succumbed.

This report present the case of a 29-year-old woman of African Descent, Gravida 1 para 1, who presented to the accident and emergency room with persistent abdominal pain, distension, and vomiting. Erect Abdominal X-ray demonstrated dilated bowel loops. Transabdominal ultrasonography revealed a complex adnexal mass measuring approximately 13.9 × 8.5 cm, involving the ovary and fallopian tube, extending into the cul-de-sac and Morrison’s pouch. A subsequent CT imaging showed Heterogeneous intraperitoneal pelvic tumours measuring 12.0 × 11.4 × 8.7 cm, associated with ascites and evidence of intestinal obstruction. Free fluid was also noted throughout the peritoneal cavity. The patient underwent an exploratory laparotomy, which identified friable ovarian masses measuring 8 × 10 cm on the left and 10 × 14 cm on the right, along with a 10 × 4 cm omental mass. Additional metastatic deposits were observed on the fallopian tubes, transverse colon, and peritoneum. All grossly visible tumours were surgically excised.

This case highlights a rare presentation of bilateral metastatic Krukenberg tumours from primary gastric adenocarcinoma in a young woman. It underscores the diagnostic challenges posed by nonspecific gastrointestinal symptoms and emphasises the importance of early, accurate diagnosis using imaging, endoscopy, histopathology, and immunohistochemistry. Multidisciplinary management is essential to guide surgical, oncologic, and palliative care, optimising outcomes and quality of life even in advanced-stage disease.

Principles and Clinical Applications of the Limberg Rhomboid Flap in Head and Neck Reconstruction

2025-12-27T07:40:30+00:00

The rhomboid flap, introduced by Professor A. A. Limberg of Leningrad, is commonly known as the Limberg flap. It is an interesting procedure for skin movement in which a rhomboid defect is created and then closed with a rhomboid-shaped flap of a similar size. The design is basically a parallelogram with two angles of 120° and two of 60°, although these can be modified to accommodate the geometry of the lesion or defect. The surgeon’s goal is to avoid unsightly scars while using the simplest, most effective reconstructive approach. The present chapter demonstrates the versatility of the rhomboid flap in the head and neck region. The first case is a 28yearold lady presenting with an extra-oral draining sinus in the left submandibular region secondary to an infected left mandibular first molar. The second case is a 35yearold lady presenting with the complaint of an ugly-looking growth over the skin of the left angle region of the mandible. These two cases, one of dentoalveolar infection and the other of cervicofacial actinomycosis, are presented, in which the unsightly scars that could have been produced by excision of the lesion alone have been avoided by the use of a rhomboid flap. The study concluded that the rhomboid flap is a very versatile and robust flap, easy to master and practice, that can be tailored to suit the surgeon’s needs.

The Role of Interval Appendectomy in the Treatment of Complicated Appendicitis: A Review of Current Perspectives

2025-12-27T07:43:25+00:00

An interval appendectomy is performed after completing non-operative treatment of complicated appendicitis to prevent recurrence. However, the indication for interval appendectomy following the management of an appendicular mass remains a subject of debate. There is currently no consensus regarding the necessity of interval appendectomy. Typically, the decision is made by the attending surgeon, with a prevailing trend towards omitting interval appendectomy in favour of monitoring patients through computed tomography and colonoscopy. The advent of advanced diagnostic tools has led to a reevaluation of the necessity of interval appendectomy. This review aims to examine the role and significance of interval appendectomy in the management of appendicular mass. A literature review was conducted by using secondary sources from 1990 to 2023. Keywords such as “interval appendectomy”, “appendicular mass”, “delayed appendectomy” and “appendicular phlegmon” were used. Based on all the available evidence that has been reviewed, interval appendectomy can be safely omitted after successful conservative treatment for an appendicular mass. Nonetheless, further randomised prospective studies are needed to assess the role of interval appendectomy in the management of appendicular mass.

Pelvic Congestion Syndrome without Venography: A Pragmatic Pathway Using Doppler Ultrasound, Laparoscopy and Ligation in Resource-Limited Settings

2025-12-29T11:16:12+00:00

Background: Pelvic congestion syndrome (PCS) is an under-recognised cause of chronic pelvic pain and a frequent driver of diagnostic wandering, particularly in low- and middle-income countries (LMICs). Recent adoption of the SVP (Symptoms-Varices-Pathophysiology) framework and more structured imaging pathways can shorten time to diagnosis and treatment.

Objective: To illustrate an SVP-harmonised, resource-adapted diagnostic–therapeutic pathway that resolves pain and ends diagnostic wandering.

Case presentation: A 42-year-old grand multipara (G9P9009) with >6-month non-cyclical pelvic pain and post-coital exacerbation underwent a stepwise work-up. Transvaginal duplex ultrasonography (TVUS) was used as the gatekeeper test; cross-sectional venous imaging and selective venography were not available. Persistent symptoms and high clinical suspicion led to diagnostic laparoscopy with planned concomitant intervention. Laparoscopy revealed parauterine varicosities consistent with venous reflux phenotype. Transperitoneal ligation of the culprit veins was performed in the same session. A venoactive agent was prescribed post-operatively for 30 days. The patient experienced complete resolution of pelvic pain and dyspareunia on follow-up, effectively terminating a prolonged diagnostic odyssey.

Conclusion: In settings where venography and endovascular therapy are limited, a graded pathway SVP-guided clinical phenotyping, standardised TVUS, and diagnostic-therapeutic laparoscopy is a pragmatic alternative that can deliver rapid, patient-centred benefit. Embolisation remains first-line where available; laparoscopy is a viable “when necessary” option. Prospective LMIC studies with harmonised outcomes are urgently needed.

A Prospective Comparative Study of Diagnostic Accuracy between TrueNat and GeneXpert for the Diagnosis of Pulmonary Tuberculosis

2025-12-29T11:18:07+00:00

Background: Tuberculosis (TB) is a chronic infectious disease caused by Mycobacterium tuberculosis (MTB), primarily transmitted via airborne particles. The currently recommended methods for diagnosing tuberculosis (TB) include molecular-based tests that can detect both TB and drug-resistant forms of the disease. Enhancing access to reliable and accurate diagnosis of tuberculosis (TB) is a priority for global TB control. Molbio Diagnostics has developed the TrueNat point-of-care molecular assays for detecting TB and rifampicin (RIF) resistance. Until 2020, the Xpert system was the only WHO-recommended option for rapid molecular detection of both TB and rifampin-resistant TB. This study aimed to compare the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of GeneXpert with TrueNat, using the MGIT test as the gold standard.

Methods: A cross-sectional comparative study involved 350 patients with suspected pulmonary TB at the Intermediate Reference Laboratory in the Government Hospital for Chest Diseases, Puducherry, India. Sputum samples were collected in pre-sterilised tubes, transported at 2–8°C to the reference laboratory, and processed using the NALC-NaOH method, with aliquots allocated for microscopy, culture, TrueNat, and Xpert testing, while excess was stored at –80°C. The BACTEC-MGIT-960 test is used to detect the growth of M. tuberculosis in drug-containing and drug-free tubes. The sensitivity, specificity, PPV, NPV, and diagnostic accuracy for tuberculosis diagnosis were calculated for TrueNat and GeneXpert and compared to the MGIT results. Data analysis was performed using MedCalc Software Ltd., specifically the Odds Ratio Calculator (Version 23.1.6).

Results: Among the 350 patients, 296 (84.57%) tested positive for TB with GeneXpert, while 280 (80.00%) tested positive with TrueNat. For the GeneXpert assay in detecting pulmonary TB in sputum samples, the sensitivity was 98.66%, the specificity was 96.15%, the PPV was 99.32%, the NPV was 92.59%, and the accuracy was 98.29%. In comparison, the TrueNat technique had a sensitivity of 93.22%, specificity of 90.91%, PPV of 98.21%, NPV of 71.43%, and accuracy of 92.86%. The agreement between the TrueNat assay and the GeneXpert method, using the BACTEC-MGIT-960 method for detecting Mycobacterium tuberculosis in pulmonary samples, was significant, with Kappa values of 0.76 (S.E.: 0.05) for TrueNat and 0.93 (S.E.: 0.03) for GeneXpert.

Conclusion: Overall, the GeneXpert assay demonstrated greater sensitivity than TrueNat in respiratory samples. It is advisable to interpret TrueNat negative results cautiously and to correlate them closely with the patient's clinical and treatment history.

Cutaneous Squamous Cell Carcinoma: A Prelude to a Sinister Outcome

2025-12-29T11:20:55+00:00

Background: Cutaneous squamous cell carcinoma (C-SCC) is the second most frequent cutaneous malignancy worldwide and represents a potentially life-threatening condition due to its ability to demonstrate rapid progression, aggressive local invasion, and metastatic spread. Although it is often regarded as relatively indolent, delayed recognition and treatment may result in advanced disease associated with substantial morbidity and mortality. This case series highlights five clinically diverse and often misleading presentations of C-SCC that mimicked benign dermatological conditions, thereby concealing their malignant potential. Emphasis is placed on the urgency of early clinical suspicion, prompt histopathological confirmation, and timely therapeutic intervention, as these measures play a decisive role in modifying disease course, reducing metastatic risk, and improving overall patient outcomes.

Objectives: This study highlights the clinical heterogeneity of C-SCC through diverse presentations, emphasising the need for diagnostic vigilance.

Methods: A case series of five patients with histopathologically confirmed C-SCC was analysed. Each case was evaluated for site, predisposing factors, morphology, and management outcomes. Case 1 involved a Post-burn scar ulcer (Marjolin’s ulcer) treated with excision and grafting, whereas Case 2 presented as a Groin and penile ulcer with nodal metastasis; the patient succumbed during chemotherapy. Case 3 was a Keratoacanthoma with adjacent SCC on the leg, managed with retinoids. Case 4 had an Inguinal lesion post-hair-plucking trauma; well-differentiated SCC. Case 5 involved Verrucous carcinoma over condyloma acuminata; partial penectomy performed.

Results: These five cases illustrate the diverse presentations and histopathological variants of Cutaneous SCC. Lesions arose in varied contexts—over scars, traumatic or infectious sites, and pre-existing dermatoses.

Conclusion: This case series highlights the broad and deceptive clinical spectrum of cutaneous squamous cell carcinoma, ranging from chronic non-healing ulcers to aggressive keratinising tumours that are frequently misinterpreted as benign conditions. Importantly, even complicated and advanced presentations of C-SCC demonstrate significant potential for improved outcomes when early intervention is undertaken under histopathological guidance. Timely diagnosis and appropriate management remain critical in offering the best chance for curative outcomes, minimising the risk of metastasis, and enhancing overall prognosis.

Recommendations: Clinicians should maintain a high index of suspicion for non-healing, indurated, or atypical cutaneous lesions.

Factors Influencing Increased Accessibility of Maternal Health and Nutrition Information on Reproductive Health Practices among Rural Females of the Reproductive Age in Western Kenya

2026-01-08T08:57:59+00:00

Maternal health and nutritional Information form the cradle of healthy genetic development and population health, safeguarding the right to life and the quality of future livelihoods. Thus, this health and nutrition information often enables most females of reproductive age 15 to 49 years, globally, regionally and locally in western Kenya, to access quality, affordable and reliable health education on maternal health care and nutrition, and to mediate a primordial prevention and reduce maternal disease burden rates. It also promotes health demography and human development, through prevention and protection missions of public health, via community health awareness and capacity building, empowering population health and promote a healthy population. This is achieved by enabling regular health education on maternal and child nutrition, for better primary prevention than cure among rural females of the reproductive age and the larger population health through synergistic community participation. It was these reasons that led to the study, which aimed to evaluate the factors influencing increased accessibility to maternal and nutritional health information and their effects on reproductive health practices among rural females of reproductive age (15–49 years) in Western Kenya. Specifically, the study focuses on determining the prevalence of population health in the accessibility to affordable maternal health and balanced diet nutrition practices, determining the level of community participation in the promotion on maternal child health nutritional health education/information for quality primordial prevention and decrease of maternal child health and nutrition, and lastly assessing how social economic, social cultural and religious beliefs influence the increased accessibility of maternal child health and nutrition health information on maternal health nutrition practices among rural females of the reproductive age in Western Kenya. The study also aimed to achieve in global health goals number 3 and 17 of Vision 2030 and beyond, in global health. Over 80% of community households have limited access to efficient, affordable, reliable, and sustainable quality maternal child health and nutrition information to promote primordial prevention in the general basic health population, especially in Sub Saharan Africa (SSA), through capacity building of health service providers and community health workers (CHWs), as their main sources of accessibility of maternal child health information, in the large diversified society of demographic health population and development, to improve the health population of the population health and their health live hoods. The study exploited descriptive, cross-sectional, cohort and triangulation designs. Purposive clusters, census retrospective and prospective sampling techniques were used to explore the ante and postnatal mothers with children aged 0-24 months as the target population. The questionnaire used as tool of survey and key informant interview and focused group discussion (FGD) was used in interview guides. Data was managed by SPSS version 27 and analysed by cross-tabulation of descriptive and inferential statistics to provide a significant inference. Results showed that health service providers and community health workers were the main sources of providing quality health education/information 97 (46.2%) and 69 (32.9%) respectively, with significant support from the global health of RR (0. 463, 0.335). The prevalence of the increased accessibility of maternal health nutrition was health/education information 101 (48%). Community awareness on the uptake of balance dietary intake from both animal proteins and plant was 67%, and majority opined significant uptake of animal protein was determined by social cultural with P value of 0.025, 95 % CI, and social economic has an influence remain insignificant with OD 1.0 and RR (0.25, 0.345), due to existing synergistic public private partnership global health to decrease unmated needs in the inequality at maternal health and nutrition community households. Need to advocate for more global health in public-private partnership participation to mediate the unmet basic needs of maternal health, nutrition and need to partner with urban reproductive of reproductive in issues of maternal health and nutrition, mediate global maternal health and nutrition global health goals number 3 and 17 of Vision 2030 and beyond to sustain quality global livelihoods and population health development.

Exploring Knowledge and Attitudes toward Surrogacy among Infertile Couples: Insights from Punjab, India

2026-01-08T09:01:58+00:00

Introduction: Surrogacy is a reproductive method in which a woman carries and delivers a baby on behalf of another couple. It may involve transferring a fertilised egg from the intended parents into the surrogate’s uterus, or in some cases, the surrogate may use her own egg and the sperm of another man to conceive. After childbirth, the surrogate mother hands over the baby to the intended or infertile couple. Although surrogacy has become a significant option for managing infertility, many couples still have limited knowledge and uncertain attitudes toward this practice.

Aim: The present study was carried out to assess the level of knowledge and attitude regarding surrogacy among infertile couples attending selected infertility clinics in Amritsar, Punjab.

Methods: A descriptive non-experimental research design was adopted for this study. The sample consisted of 100 infertile couples selected through purposive sampling from Satjot Human Reproduction Centre, KD Hospital, and other infertility clinics in Amritsar. A structured questionnaire with 18 knowledge-related questions and an attitude scale with 16 statements was used to gather data. Statistical analysis was done using descriptive and inferential methods.

Results: The findings showed that most of the participants (87%) had an average level of knowledge, followed by 11% with good knowledge, and only 2% with poor knowledge about surrogacy. With respect to attitude, 62% of couples had a negative attitude, while 38% displayed a positive attitude. No significant relationship was found between knowledge and selected demographic variables such as age, religion, education, and family income. However, the type of family, duration of marriage, and number of infertility treatment attempts were found to have a statistically significant association at p < 0.05.

Conclusion: The study concluded that although the majority of infertile couples had moderate knowledge regarding surrogacy, their attitudes were mostly negative. This highlights the need for awareness and counselling programs to provide accurate information about medical, emotional, and legal aspects of surrogacy. Enhancing knowledge through education may help couples make more informed and positive decisions regarding this reproductive option.

Injury Characteristics and Request for Discharge against Medical Advice among Road Trauma Patients

2026-01-08T09:04:16+00:00

Background: Discharge Against Medical Advice (DAMA) occurs when a patient leaves the hospital contrary to the managing physician's recommendation. DAMA, with its attendant effects of increased healthcare cost and mortality, is common globally. Therefore, DAMA must be continuously brought into public discourse, and strategies to address it should be explored.

Aim: The aim of this study was to highlight the Patterns of injuries by Road Traffic Accident victims, the implications of discharge against Medical Advice on certain critical injuries, and the importance of follow-up.

Methods: A retrospective study was carried out at the Federal Medical Centre Makurdi, a tertiary health facility in North Central Nigeria, from January 2021 to March 2022. Medical records (case notes) of 121 patients who were involved in Road Traffic Accidents (RTAs), and were admitted either into the ward through the Accident and Emergency Unit, or at the Accident and Emergency Unit of the hospital, were retrieved and analyzed against such variables as age, sex, occupation, resident, types of injury, and length of hospital stay. Descriptive Statistics were deployed using Microsoft Excel and Statistical Package for Social Sciences (SPSS) to analyse the data.

Results: DAMA rate was 12.4% (n=15), of which 8 (6.6%) were females, and 7 (5.7%) were males. Head injury was the commonest injury, 8 (53.3%), seen, while musculoskeletal injuries were 7 (46.7%). The majority of the victims, 6, were in the age group, 30-39 years, with an average age of 37.2. Farmers and housewives were the dominant occupational groups involved. The average hospital stay was 6 days. There was no form of health insurance coverage or follow-up protocol.

Conclusion: DAMA for critically injured patients is common in our environment, and there is no known established follow-up system. There is no health insurance coverage. Physicians must strive to track and follow up on these patients to improve outcomes.

Recent Advances in the Surgical Management of Acute Appendicitis: A Review

2026-01-08T09:06:40+00:00

The management of acute appendicitis typically involves performing an appendectomy, which can be executed using either an open or laparoscopic approach. Since its inception, laparoscopic appendectomy has been utilised for both uncomplicated and complicated cases of appendicitis. It has become the preferred method of performing an appendectomy in most Western countries. This minimally invasive technique is associated with reduced postoperative complications, earlier ambulation, and expedited recovery. Recent advancements in minimally invasive surgery include single-incision laparoscopic appendectomy and natural orifice transluminal appendectomy, both of which are employed in the treatment of acute appendicitis. In this review, we will examine the role of laparoscopic appendectomy, single incision laparoscopic appendectomy, and natural orifice transluminal appendectomy in the management of acute appendicitis.

Using Immunohistochemistry to Manage Diagnostic Challenges in Pediatric Small Round Cell Tumours

2026-01-08T09:09:21+00:00

Background: Pediatric small round cell tumours (SRCTs) are a group of aggressive cancers that look very similar under the microscope, making them difficult to tell apart based on appearance alone. An accurate diagnosis is critical because each type requires different treatment. Immunohistochemistry (IHC) has emerged as an essential adjunct in the diagnostic workup, enabling precise lineage assignment through the detection of differentiation-specific antigens. Despite its widespread use, diagnostic ambiguity persists, particularly in resource-limited settings where antibody panels may be restricted or tissue preservation suboptimal.

Aim: This study aimed to test how effective a standard panel of immunohistochemistry (IHC) stains is at providing a definitive diagnosis for these challenging tumours.

Methods: A prospective study was conducted on 100 children with SRCTs. Cases were included if they showed histological evidence of a malignant SRCT on haematoxylin and eosin (H&E)-stained sections, had adequate formalin-fixed paraffin-embedded (FFPE) tissue for a complete immunohistochemical (IHC) workup. After an initial review under the microscope, all cases were tested with a targeted IHC panel designed to identify different tumour lineages (including CD99, myogenin, CD45, and synaptophysin).

Results: Initial microscopic examination failed to provide a specific diagnosis in 71% of cases, labelling them only as "undifferentiated." The IHC panel successfully resolved 99% of all cases, providing a specific diagnosis. The Ewing sarcoma family (50%) was the most common tumour, followed by embryonal rhabdomyosarcoma (17%).

Conclusion: A systematic IHC panel is a highly effective and essential tool for diagnosing pediatric SRCTs. It resolves the vast majority of ambiguous cases, ensuring that children receive the correct diagnosis as the crucial first step towards appropriate therapy. Study limitations include a single-centre, prospective design, which may introduce selection bias, as evidenced by a high proportion of bone and soft tissue tumours. Future investigation should involve multicenter cohorts with more diverse tumour types to validate the generalizability of these findings.