International Journal of Medical and Biomedical Studies

Fibromatous Epulis of the Maxillary Gingiva in a Hypertensive Patient: A case report

Chindy Septia Ningsih — 2026-01-19

Background: Fibromatous epulis is a benign, reactive, non-neoplastic gingival lesion characterized by fibrous connective tissue proliferation secondary to chronic local irritation. The lesion typically originates from the gingival connective tissue, periodontal ligament, or periosteum and is commonly associated with local irritants such as dental plaque, calculus, residual root fragments, and poor oral hygiene. Surgical excision is the treatment of choice; however, management in patients with hypertension requires special perioperative considerations due to the increased risk of bleeding and potential cardiovascular complications.

Case Presentation: A 59-year-old female presented with a large, slowly growing mass in the right maxillary gingiva causing difficulty in mastication and speech. The lesion had been present for approximately 1.5 years. Clinical examination revealed a pedunculated, elastic mass measuring 4×4×3 cm extending from the right maxillary first premolar to the maxillary tuberosity. The patient had a history of hypertension and was taking amlodipine. Radiographic examination showed no bony involvement, while panoramic imaging revealed residual roots of teeth 14 and 15. The provisional diagnosis was a benign soft tissue tumor, with fibromatous epulis as the differential diagnosis.

Management and Outcome: Preoperative medical consultation was performed, and antihypertensive therapy with amlodipine was administered to achieve adequate blood pressure control prior to surgery. Following stabilization, complete surgical excision of the lesion along with extraction of the retained roots was carried out under general anesthesia, and local anesthetic infiltration with a vasoconstrictor is also administered to ensure optimal hemostasis, postoperative pain control, reduction of surgical stress response, and improved postoperative patient comfort. The lesion was completely excised, accompanied by extraction of residual root fragments and bone contouring. Histopathological examination confirmed the diagnosis of fibromatous epulis, characterized by hyperplastic stratified squamous epithelium and fibrous collagenous connective tissue without malignant features. Postoperative healing was uneventful, with no bleeding or recurrence observed at the two-week follow-up.

Conclusion: Complete surgical excision combined with elimination of local irritative factors is an effective treatment for fibromatous epulis. Careful systemic, anesthetic, and psychological management is essential when performing oral surgical procedures in hypertensive patients to minimize complications.

Keyword: Fibromatous epulis, gingival enlargement, hypertension, oral surgery

Early Indicators of Metabolic Risk: A Study on Anthropometric and Cardiovascular Parameters in Primary School Children

Gadugoyyala Guna Sri Phani Ajay — 2026-01-19

The rising prevalence of childhood obesity and metabolic abnormalities represents a growing public health concern, particularly in low- and middle-income countries. Early metabolic risk often manifests during childhood through subtle anthropometric and cardiovascular changes that precede clinically apparent disease. Identifying these early indicators is essential for timely prevention of future cardiometabolic disorders

Corneal Endothelial cell changes in diabetic patients after small incision Cataract Surgery

Sunil Kumar — 2026-01-20

Background: Diabetes mellitus is known to cause structural and functional alterations in the corneal endothelium, which may increase susceptibility to surgical trauma during cataract extraction. Small incision cataract surgery (SICS) is widely performed in developing countries; however, data on corneal endothelial changes following SICS in diabetic patients remain limited.

Aim: To evaluate changes in corneal endothelial cell density and morphology in diabetic patients following small incision cataract surgery.

Materials and Methods: This prospective observational study was conducted at Patna Medical College from 1 September 2024 to 1 September 2025. A total of 68 diabetic patients with senile cataract undergoing uneventful SICS were included. Preoperative and one-month postoperative corneal endothelial parameters, including endothelial cell density, coefficient of variation, and percentage of hexagonal cells, were assessed using specular microscopy. Statistical analysis was performed to compare preoperative and postoperative findings.

Results: The mean preoperative endothelial cell density was 2468 ± 218 cells/mm², which decreased significantly to 2216 ± 205 cells/mm² at one month postoperatively (p < 0.001). A significant increase in coefficient of variation and a reduction in hexagonality were observed postoperatively, indicating increased polymegathism and pleomorphism (p < 0.001). Greater endothelial cell loss was noted in patients with longer duration of diabetes. Transient corneal edema was observed in a small proportion of patients and resolved with routine management.

Conclusion: Small incision cataract surgery in diabetic patients is associated with significant endothelial cell loss and morphological changes, particularly in those with longer duration of diabetes. Careful preoperative assessment and meticulous surgical technique are essential to minimize corneal endothelial damage in this high-risk group.

Keywords: Diabetes mellitus; Corneal endothelium; Small incision cataract surgery; Endothelial cell density; Specular microscopy

Correlation of Cytology-Positive Tuberculosis with TB PCR: A Prospective Observational Study

Pratibha Srivastava — 2026-02-11

Background: Cytological identification of granulomatous inflammation is widely used for the diagnosis of tuberculosis, particularly in extrapulmonary cases. However, cytology alone cannot provide definitive etiological confirmation, and Ziehl–Neelsen staining often shows low sensitivity. Molecular techniques such as tuberculosis polymerase chain reaction (TB PCR) enable rapid and sensitive detection of Mycobacterium tuberculosis and may complement cytological diagnosis.

Objective: To evaluate the correlation between cytology-positive granulomatous lesions suggestive of tuberculosis and TB PCR results.

Methods: This prospective observational study was conducted in the Department of Pathology & microbiology, Patna Medical College and Hospital, Patna, from August 2024 to December 2025. A total of 135 patients with cytological evidence of granulomatous inflammation on fine-needle aspiration cytology were included. Cytological findings were assessed using May–Grünwald–Giemsa and Ziehl–Neelsen staining. Samples were subsequently subjected to TB PCR for detection of Mycobacterium tuberculosis complex DNA. Cytology findings were correlated with TB PCR results, and statistical analysis was performed to assess diagnostic agreement.

Results: TB PCR detected Mycobacterium tuberculosis DNA in a significant proportion of cytology-positive cases. Higher PCR positivity was observed in lesions showing granulomas with necrosis compared to those without necrosis. TB PCR demonstrated additional diagnostic value in cytology-positive but Ziehl–Neelsen–negative cases. A statistically significant correlation was found between cytological features suggestive of tuberculosis and TB PCR positivity.

Conclusion: There is a significant correlation between cytology-positive granulomatous lesions and TB PCR results. TB PCR serves as a valuable adjunct to cytology by improving diagnostic confirmation, particularly in smear-negative cases. The combined use of cytology and molecular testing enhances diagnostic accuracy for tuberculosis in high-burden settings.

Keywords: Tuberculosis; Granulomatous inflammation; Fine-needle aspiration cytology; TB PCR; Extrapulmonary tuberculosis