ABSTRACT
PURPOSE: The caruncle is a unique anatomical site in the human body, comprising various structures derived from the surface ectoderm and mesoderm. Caruncular lesions can range from benign to malignant and present challenges in accurate diagnosis and timely management due to their hidden nature and proximity to the lacrimal sac. This study aims to provide a comprehensive description of caruncular lesions, presenting the first Indian case series on this topic. METHODS: Ethical approval was obtained, and data collection was conducted at a tertiary care center in India. A retrospective analysis was performed on 44 patients with caruncular lesions treated between 2013 and 2020. Detailed patient histories, clinical examinations, slit lamp imaging, and excision biopsies were conducted. Histopathological examination of the specimens was carried out. RESULTS: The study included 42 cases of caruncular lesions, with a mean age of 31.09 years. The majority of cases were male (54.54%). Benign lesions accounted for 84.09% of the cases, while premalignant and malignant lesions accounted for 11.36% and 4.54%, respectively. Papilloma and nevus were the most common lesions, with 11 cases each. All caruncular lesions were successfully and completely excised without complications. Histopathological examination confirmed the accuracy of the diagnoses, with an 84.09% concordance rate between clinical assessment and pathological diagnosis. CONCLUSION: This case series reveals a predominance of benign lesions among individuals in their early thirties. The successful excision of all lesions with a high concordance rate between clinical assessment and histopathological diagnosis underscores the importance of timely and accurate management.
ABSTRACT
Introduction Cerebrovascular accidents or strokes are a major cause of mortality and morbidity in today's world. Post-stroke disabilities like paralysis, dementia, etc., can affect the quality of life of patients as well as their families. A combined increase in neutrophils and a decrease in lymphocytes during inflammation in stroke manifests as an elevated neutrophil-to-lymphocyte ratio (NLR), thereby indicating the severity of neural damage. Aim We aimed to determine if an elevated NLR observed on the day of hospital admission can predict a higher risk of in-hospital mortality in stroke patients. Confirmatory results could aid in developing risk stratification for management, ultimately improving clinical and functional outcomes. Materials and methods Sixty stroke patients were monitored throughout their hospital stay in this prospective cohort study. NLR was calculated at admission using routine complete blood counts. The data were analyzed using SPSS Software v23.0 (IBM Corp., Armonk, NY). An unpaired t-test was used to compare the means between the two groups. Categorical data were analyzed using the chi-square test. The receiver operating curve (ROC) was plotted and used to ascertain if a cut-off value of NLR could be obtained to predict in-hospital mortality in stroke patients. P values <0.05 were considered statistically significant. Results About 23.3% (n=14) of the patients died during their hospital stay, with no significant differences between the survivor and death cohorts in terms of comorbidities like diabetes and hypertension. The mean NLR calculated within 24 hours of hospital admission in patients who died (NLR=8.47 (standard deviation (SD)=4.67)) was significantly higher (p=0.009) than in those who survived (NLR=5.84 (SD=2.62)). Upon ROC analysis, patients with NLR >6.03 on the day of admission demonstrated a higher risk of in-hospital mortality (p=0.015 (95% CI: 0.577-0.855)). An area under the curve (AUC) of 0.72 with a sensitivity of 92.86% and a specificity of 54.35% was obtained. Conclusions Elevated NLR (cut-off >6.03) obtained within 24 hours of hospital admission is an indicator of a higher risk of in-hospital mortality in stroke patients. Hence, patients presenting with a high NLR at admission can be prioritized for personalized targeted treatment, potentially reducing mortality and post-stroke complications.
