Background: Lymph node yield (LNY) and lymph node ratio (LNR) are increasingly recognized as potential prognostic factors in oral cavity squamous cell carcinoma (OCSCC). Their prognostic significance in clinically node-negative patients undergoing elective neck dissection remains incompletely defined. Aims and Objectives: To evaluate the association of LNY and LNR with overall survival (OS) in patients with clinically and radiologically node-negative OCSCC undergoing elective neck dissection. Methodology: This retrospective cohort study included 250 consecutive patients with cN0/rN0 OCSCC treated with curative-intent primary tumor resection and elective neck dissection between January 2022 and January 2026. LNY was defined as the total number of lymph nodes examined and categorized as <18 or ≥18 nodes. LNR was calculated as the number of metastatic lymph nodes divided by the total number examined. Survival was assessed using Kaplan-Meier analysis and the log-rank test. Cox regression was used to evaluate prognostic associations. Results: The median LNY was 20 nodes, with 104 (41.6%) patients having <18 and 146 (58.4%) having ≥18 nodes. Occult nodal metastases were identified in 78 (31.2%) patients, and ENE was present in 26 (10.4%). Five-year OS was 67.41% for LNY <18 versus 72.73% for ≥18 (p=0.234). In contrast, 5-year OS was 89.92% versus 55.67% according to LNR category (p=0.004). Conclusions: LNY ≥18 was not significantly associated with OS, whereas LNR demonstrated a significant association with survival. LNR may provide useful prognostic information in clinically node-negative OCSCC undergoing elective neck dissection.

Background: Ketoacidosis is a clinically important cause of high-anion-gap metabolic acidosis in the Emergency Department. Diabetic ketoacidosis (DKA) is common, whereas starvation ketoacidosis (SKA) is less frequently recognized and can present with substantial ketonaemia despite normal or near-normal glucose concentrations. Objectives: To compare the clinical presentation, precipitating factors, biochemical profile, and severity of acidosis in patients with DKA and SKA presenting to an Emergency Department. Methods: This prospective observational comparative study was conducted in the Emergency Department of Manipal Hospital, Varthur Road, Bengaluru, Karnataka, India, from February to June 2026. Adults with biochemically confirmed ketoacidosis were consecutively evaluated. Clinical features, precipitating factors, glucose, glycated haemoglobin, blood pH, bicarbonate, anion gap, β-hydroxybutyrate, electrolytes, renal indices, lactate, and calculated serum osmolality were recorded. Between-group comparisons were performed using appropriate parametric or categorical tests. Results: Of 108 patients assessed, 100 were analysed: 70 with DKA and 30 with SKA. Mean age was 42.6 ± 15.8 years and 56.0% were male. Polyuria/polydipsia was more frequent in DKA, whereas generalized weakness was more frequent in SKA. DKA showed higher glucose (392.6 ± 118.4 vs 87.9 ± 21.6 mg/dL), HbA1c (10.3 ± 2.1% vs 5.4 ± 0.5%), anion gap (24.8 ± 5.7 vs 20.5 ± 4.4 mmol/L), and β-hydroxybutyrate (5.7 ± 1.8 vs 4.3 ± 1.5 mmol/L), with lower pH and bicarbonate. Moderate-to-severe acidosis occurred in 72.9% of DKA and 40.0% of SKA patients. Conclusion: DKA and SKA share overlapping symptoms but demonstrate distinct glycaemic and acid-base profiles. Simultaneous assessment of glucose, β-hydroxybutyrate, pH, bicarbonate, anion gap, and dietary history can support early differentiation in emergency care.