Abstract: This study was designed to examine the impact of public health expenditure on health outcome in India. The study used time series data for the period from 1990 to 2024. Using an Autoregressive Distributed Lag Model (ARDL) Bound test approach, the study analyses the short run and long run dynamics between public health expenditure and health outcome. ARDL bound test confirms the existence of a long-run relationship among the variables. The findings also indicate that increased public health expenditure is associated with significant improvements in health outcome in the short run. The study provides evidence that sustained investments in health sector contribute to better health outcomes.
Key words: Public Health Expenditure, Infant mortality, Maternal mortality, life expectancy, ARDL, India

Abstract: Introduction: Ovarian tumors comprise a heterogeneous group of neoplasms with varied biological behavior and significant morbidity and mortality. Accurate intraoperative differentiation between benign, borderline, and malignant ovarian lesions is crucial for guiding appropriate surgical management. While frozen section analysis is considered the gold standard, its limited availability in resource-constrained settings necessitates reliable alternatives. Scrape cytology offers a rapid, simple, and cost-effective intraoperative diagnostic option. Aims: To evaluate the diagnostic value and reliability of scrape cytology in ovarian lesions, with the aim of correlating intraoperative cytological impressions with confirmed histopathological diagnoses. Methodology: This cross-sectional study included 166 surgically excised ovarian neoplasms over a three-year period (June 2022–May 2025). Scrape cytology was performed intraoperatively from freshly cut tumor surfaces, and smears were stained with hematoxylin and eosin. Tumors were categorized cytologically as benign, borderline, or malignant and compared with histopathological diagnosis, which served as the reference standard. Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and overall diagnostic accuracy was calculated. Results: Of the 166 cases, 126 (75.9%) were benign, 2 (1.2%) borderline, and 38 (22.9%) malignant on histopathology. Scrape cytology demonstrated a sensitivity of 92.5%, specificity of 99.2%, PPV of 97.4%, NPV of 97.6%, and an overall diagnostic accuracy of 97.6%. Discordance was observed in seven cases, predominantly involving mucinous and borderline tumors. Conclusion: Scrape cytology is a highly accurate and dependable intraoperative diagnostic technique for ovarian tumors. Despite limitations in borderline and mucinous lesions, it serves as a valuable adjunct to histopathology, particularly in settings lacking frozen section facilities.
Key words: Ovarian tumors, Scrape cytology, Intraoperative diagnosis, Histopathology, Diagnostic accuracy

Abstract: A case of a 31‐year‐old female with osteolytic lesion in the left femur, whose clinical presentation and histological examination was imitating various diseases, making it a diagnostic challenge. The patient underwent curettage with bone grafting and open reduction internal fixation by nailing. She was diagnosed to have IgG4-related disease on microscopy and IHC in addition to serological tests for which she was treated with low dose corticosteroids and showed significant improvement in well-being. IgG4-related disease (IgG4-RD), is a rare fibro-inflammatory disorder which is characterized by fibrosis and increased IgG4 plasma cells. It may affect any organ but most commonly affects the pancreas, kidneys, orbit, salivary glands, retroperitoneum, skull bones of head and neck. However, involvement of long bones is relatively uncommon. As these lesions mimic other tumours, infections, and immune-mediated diseases, IgG4-RD affected patients are frequently misdiagnosed as cases of malignancy or other disorders. This disease is usually underdiagnosed due to lack of systemic approach. This case is reported for its rarity.
Key words: IgG4-related systemic disease, obliterative thrombophlebitis, storiform fibrosis, osteolytic lesion, plasma cells.

Abstract: Metastatic renal cell carcinoma (RCC) to the oral cavity is extremely rare, accounting for less than 1% of oral malignancies. We report a case of an 80-year-old male, presented with a swelling over labial aspect of lower lip for 3 months. Excision biopsy revealed features of a Vascular tumour with epithelioid morphology. Immunohistochemistry showed strong positivity for PanCK, CD10, nuclear PAX8, and membranous CA IX, confirming metastatic RCC. Prompt biopsy along with immunohistochemistry established the accurate diagnosis. This case underscores the need to consider metastatic disease in the differential diagnosis of atypical oral lesions.
Key words: Lip, Renal cell carcinoma, Immunohistochemistry

Abstract: Primary thyroid lymphoma is a rare hematological disease that represents 1-5% of all thyroid malignancies and 2-7% of extranodal lymphomas, with an estimated annual incidence 2 per 1 million. It is typically seen in women over 50 years old with Hashimoto’s autoimmune thyroiditis. Patients usually present with a painless rapidly growing mass in the cervical region at the level of the thyroid gland. Due to the rapid expansion of the mass patients frequently develop obstruction of the esophagus, trachea and local tissues. Primary thyroid lymphoma should be differentiated with anaplastic thyroid carcinoma, since they have similar clinical presentation. The prevailing PTL histological types are diffuse large B-cell lymphoma (68%) and MALT lymphoma (24%). Patient prognosis mainly depends on the stage, histology, age at the diagnosis, IPI index, treatment modalities applied. The management of primary thyroid lymphoma patients often requires a multidisciplinary team involving an oncologists, endocrine surgeon, endocrinologist and other specialists. Current article presents a rare case of the primary thyroid lymphoma which developed during 1 month and required multidisciplinary team and gastrostomy due to a rapidly enlarged neck mass.
Key words: thyroid, thyroid mass, core needle biopsy, thyroid lymphoma, thyroid cancer, anaplastic carcinoma.

Abstract: Medullary thyroid carcinoma (MTC) is a rare neuroendocrine tumour of the thyroid C-cells. Using FNAC as primary diagnostic tool for thyroid lesions it is challenging for accurate diagnose of Medullary thyroid carcinoma due to its diverse cytological presentations, particularly the peculiar one spindle cell variant. Details in this case report exhibit a rare case of spindle cell variant in MTC. A 42-year-old female presented with a solitary, painless neck swelling, hoarseness, and dysphagia. Cytology smears showed high cellularity with predominantly dispersed spindle-shaped cells exhibiting pleomorphic hyperchromatic nuclei with stippled nuclear chromatin and scant cytoplasm. Congo red staining confirmed amorphous amyloid-like material observed in the background. Elevated serum calcitonin levels supported the provisional diagnosis of spindle cell MTC, which was further confirmed by histopathology and immunohistochemistry. This case highlights the relevance of recognising the characteristic cytomorphological features of this rare variant on FNAC, supplemented by ancillary studies, to ensure early and accurate pre operative diagnosis for appropriate management, improved treatment outcome and prognosis.
Key words: Medullary carcinoma, thyroid, spindle cell variant, neuroendocrine tumour

Abstract: Microsporidia is a family of rare, spore-forming organisms which tend to infect humans and animals. In recent decades Microsporidia have attracted greater attention due to their association with immunocompromised patients but the incidence of keratitis in immunocompetent individuals is rare, accounting for 0.4%. This study aims to report two similar cases of keratoconjunctivitis in immunocompetent patients presented with complaints of watering, irritation, redness and pain in the eye. On examination circumcorneal congestion on conjunctiva was present and on slit lamp examination stuck on appearance in corneal stroma was seen. On microscopy Gram stain showed violet colored ovoid spores. Modified acid fast stain showed acid fast bright red spores against blue background. On Giemsa stain blue spore-like structures were seen.These findings were suggestive of microsporidial keratitis and the patients were started on fluconazole eye drops. Patients were reviewed after starting therapy and were symptomatically better and cornea was found to be clear.
Key words: Microsporidia, Microsporidial keratitis, Keratoconjunctivitis, Corneal infection