Background: Rabies being a 100% fatal disease, is also 100% preventable if timely postexposure prophylaxis (PEP) is taken. The knowledge of adult decision-makers of the family becomes pivotal to understanding their health-seeking behavior so that appropriate actions can be planned to decrease the incidence of human rabies. Objectives: To assess the knowledge about rabies prevention and to determine the factors influencing their knowledge. Materials and methods: A community-based; cross-sectional study was conducted among 86 adults in an urban poor locality of Bengaluru. A House-to-house survey was done and the knowledge of the adult responsible respondents regarding transmission and prevention of rabies was collected using a predesigned, pretested questionnaire in the local language. Data were entered in Microsoft Excel and analyzed using Statistical Package for the Social Sciences (SPSS) version 20.0. Results were expressed using descriptive and inferential statistics. A p < 0.05 was considered statistically significant. Results: The study included 86 adults with their mean age being 34.16 ± 12.12 years. The majority of them were males (67.4%) and most of the study subjects were literate (88.3%). The knowledge regarding transmission of the disease, animals involved, immediate measures to be taken and PEP was low. The factors influencing the knowledge of the study subjects were found to be significantly associated with their literacy status. Conclusion: Knowledge regarding prophylaxis against rabies is inadequate among adults in the urban poor locality. There is a need for regular, responsive, social, and behavior change communication/programs to improve their knowledge on prevention of the disease and increase demand/utilization of essential health services.

Introduction: Although intraoperative monitoring and control of cuff pressure are suggested to reduce the incidence of sore throat and other complications postoperatively, it is not routinely practiced by many anesthesiologists. In this study, we assessed the effect of patient positioning and pneumoperitoneum on endotracheal cuff pressure during laparoscopic surgeries with nitrous oxide (N₂O) anesthesia in the Trendelenburg position and reverse Trendelenburg position. Materials and methods: It was a prospective observational study on 96 patients scheduled for laparoscopic cholecystectomy (LAP CHOLE) and laparoscopic hysterectomy (TLH). Cuff pressure was measured at the time of first inflation of cuff up to 20–30 cm H₂O, and airway pressure was noted as zero reading. Cuff pressure was measured after 5 minutes subsequently, before pneumoperitoneum, 5 minutes after pneumoperitoneum, and at 15-minute intervals till desufflation and prior to extubation. Results: In our study, the increase in cuff pressure in the Trendelenburg position was 33.92 ± 4.32, 30.19 ± 3.07, and 31.10 ± 3.50, and in the reverse Trendelenburg position was 33.25 ± 3.82, 32 ± 6.45, and 30.81 ± 5.82 after 5, 15, and 30 minutes after the start of pneumoperitoneum, respectively. There was no significant difference between the two groups. The number of deflations was higher during the first 60 minutes for both groups. Our study showed a poor correlation between the airway pressures and ETT cuff pressures, contrary to previous studies. Conclusion: The use of N₂O increases the cuff pressure, and ETT cuff pressure continues to increase during the 1st hour of N₂O anesthesia. There is no correlation between airway pressures and endotracheal cuff pressure when the airway pressures are maintained within normal limits. So, regular monitoring of endotracheal tube (ETT) cuff pressure should be a part of the safe practice of anesthesia where N₂O is used.

Introduction: Medical teaching is not restricted to didactic lectures alone. To generate interest among students and to make learning more proactive, teaching methods such as quizzes, role-plays, and seminars are gaining more importance. Similarly, poster presentations are also used as an academic method to gain knowledge. A poster presentation is a visual treat to the eye and provides an eagle's view of the topic. Aim and objectives: To assess poster and model competition as a teaching–learning method for Indian medical graduates (IMGs). Materials and methods: A poster and model competition was planned on the topic “Cardiovascular Physiology” among 14 teams in the Department of Physiology at a medical college for first-year IMGs. Seven faculty members voluntarily agreed to guide the students. A prevalidated questionnaire was used to collect feedback from both the students and the faculty. Results: Out of 200 students, 111 participants gave feedback. The mean age of the students was 19.4 ± 1.36 years; males were 51.4% and females were 48.6%. The majority of them agreed that this method helped them understand the topic better, added to didactic lectures, enhanced their confidence, and increased their expertise in the topic. Seventy-one percent of them preferred group activities over individual assignments. Eighty-one percent of students opined that such presentations should be done in the future as well. Conclusion: The poster/model competition did inculcate enthusiasm in the students. It also allowed the faculty to understand the students better. The poster/model competition can be used as a novel, innovative, interest-generating teaching–learning tool to encourage students and fortify their learning.

Background: The COVID-19 pandemic was controlled by mass vaccination of the population of all countries throughout the world. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) affected both pregnant and lactating mothers equally. The objectives of the study were to provide information on vaccine-induced breast milk antibody immunoglobulin (Ig) A and IgG response in the serum of mothers and to observe the persistence of these antibodies postvaccination at different periods in lactating women. Materials and methods: The study is a longitudinal, prospective, monocentric study in a tertiary care hospital for the duration of 1 year from March 2022 to 2023. A total of 150 blood and 150 breast milk samples were collected from 50 participants at three different intervals. The samples were collected within 1 week (T1), 6 weeks (T2), and 6 months (T3) from delivery. SARS-CoV-2 specific IgA antibody was detected by enzyme-linked immunosorbent assay (ELISA) using a COVID-19 human IgA ELISA kit from Raybio. ELISA detected SARS-CoV-2 specific IgG antibody using the access SARS-CoV-2 IgG assay. Results: The mean serum concentration of SARS-CoV-2 receptor binding domain-specific IgG (RBD-S-IgG) antibodies [signal-to-cutoff ratio (S/CO)] in vaccinated individuals were 5.35 (6.26), 9.80 (10.68) and 6.89 (8.93) in 1st week, 6th week, and 6th month, respectively. The mean breast milk concentration of SARS-CoV-2 RBD-S-IgA antibodies (units/mL) was 75.93 (106.19), 109.02 (150.50), and 318.23 (443.82) in 1st week, 6th week, and 6th month respectively. Around 78% of study participants had anti-SARS-CoV-2 IgG in their serum, and 88% of them had anti-SARS-CoV-2 IgA in their milk at 1st week. Conclusion: Postvaccination, breastfeeding should be encouraged in lactating mothers, as it will have the additional benefit of providing secretory IgA against SARS-CoV-2.

Background: In the current perioperative care, the practice of getting routine investigations and specialty opinions for minor and intermediate surgeries is questioned as it adds to the cost of healthcare without any change in perioperative management and outcome. We did a retrospective study to find out the validity of cardiology opinions for minor and intermediate surgeries in a tertiary care teaching center. Objective: To investigate the role of cardiology opinion for intermediate/low-risk surgeries in terms of change in treatment, change in anesthetic management, further coronary artery disease (CAD) workup, and predicting adverse perioperative events. Materials and methods: Retrospective study of the case files of patients who had undergone minor/intermediate risk surgeries. Only those patients’ case files with good functional capacity were considered. We looked for the reason for obtaining cardiology opinion, the outcome of opinion in terms of change in treatment, further workup, advice for any change in anesthetic management, and predicting adverse perioperative outcomes. Results: A total of 32% of the opinions were sought for patients without any risk factors for major adverse cardiac events (MACE). Overall, 73 requests by both surgeons and anesthesiologists (69%) did not specify the reason for cardiology opinion. Clearance for the surgery was the most common reason quoted by surgeons for cardiology consultation. Electrocardiogram (ECG) changes were the reason for this, as quoted by anesthesiologists. Antihypertensive medications were started only for four patients. Except in one case, none of the patients had any problems during the perioperative period. All cases were managed as per routine protocols. Conclusion: Cardiology opinion for minor/intermediate risk surgeries has not contributed to perioperative management or in predicting complications. The practice of obtaining cardiology opinions does not follow the guidelines. Cardiology consultation for risk stratification and clearance for surgery should not be done; rather, a request should be made if it is going to change the course of perioperative management.

Background and aim: Patients undergoing spine surgeries experience severe postoperative pain. This study compares an opioid-free anesthesia (OFA) approach with conventional opioid-based anesthesia (OBA) in patients undergoing spine surgery and its impact on perioperative pain, opioid consumption, hemodynamic stability, and adverse effects. Materials and methods: A total of 56 patients undergoing elective spine surgery were randomly assigned into two groups. Group OFA received intravenous 1 gm paracetamol, 2 gm MgSO₄, 100 mg lignocaine, 8 mg dexamethasone, and 0.3 mg/kg ketamine in 100 mL normal saline as a mixture over 20 minutes prior to induction. Group OBA received 100 mL saline over 20 minutes. General anesthesia was administered with 2 µg/kg fentanyl diluted to 10 mL in group OBA, and group OFA received 10 mL of normal saline 5 minutes prior to induction. Results: Reduced 24-hour mean visual analog scale (VAS) was seen in the OFA group compared to the OBA group (5.54 vs 5.93) along with significant suppression of heart rate to laryngoscopy, reduced intraoperative fentanyl consumption (3.6 vs 100%), and comparable postoperative tramadol consumption. Conclusion: This nonopioid multimodal regime is a safe and effective method that provides adequate pain relief and opioid-sparing effects.

Background: Intestinal parasites are widely prevalent in developing countries due to poverty, illiteracy, malnutrition, health status, contaminated drinking water resources, etc. The prevalence of amoebiasis varies in the different parts of the world. The diagnosis and conclusion of Entamoeba histolytica infection is difficult. In most developing countries, the diagnosis of Entamoeba infection is made by microscopic examination, which is usually subjective, has low sensitivity and specificity, and is also associated with high false positivity rates. Materials and methods: The present descriptive observational study was planned to study all the suspected patients having gastrointestinal infections attending a tertiary care teaching hospital over a period of 6 months. Fresh stool samples were collected, and macroscopic and microscopic examination was done using a wet mount and iodine mount. The serum samples of routine stool microscopy-positive patients were processed for amoebic serology and were then tested for immunoglobulin G (IgG) antibody levels using an enzyme immunoassay. Results are analyzed statistically. Result: Eight stool samples (1.55%) were found to be positive for E. histolytica/dispar/moshkovskii. Out of these positive patients, five were positive for amoebic serology. The majority of the patients belonged to the 26–36 years age-group, with male-to-female ratio of 1.67/1. A predominance of positive cases was observed in September and October. Conclusion: The prevalence of intestinal parasitic infections is low in the present study. This depicts the improvement in the living conditions, hygiene practices, epidemiological surveillance, and the systematic management of populations.

Exam anxiety is one of the most common problems that learners face during their studies and affects their academic performance. Music therapy (MT) is defined as the use of music for therapeutic purposes and to achieve nonmusical goals such as anxiety reduction. The aim of the present research is to evaluate the effect of mindfulness-guided MT intervention using an instrumental rendition of raga Hamsadhvani in relieving exam-related anxiety among Indian medical students. Fifty-five exam-going postgraduate students from departments of anesthesia, obstetrics and gynecology, ear, nose, and throat (ENT), general surgery, and pediatrics were included in the study. The study population of students was provided set of two proformas that included the Beck Anxiety Inventory (BAI) and the World Health Organization (WHO) Well-Being Index (WHO-5) for self-reported scoring. During 2-week intervention period, students were asked to listen to 10 minutes of instrumental raga Hamsadhvani everyday via a link shared on their phones, 5 minutes each in the morning and evening. The pre- and postintervention proformas were measured and recorded on day 0 and day 15 of the study. The self-reported BAI score and WHO Well-Being score was compared before and after the MT intervention. There was reduction in both the scores which were found to be statistically significant (p-value < 0.05). The results indicate that with the help of receptive MT, the students were able to cope with their exam-related anxiety and showcased an enhanced well-being index.

Introduction: The relationship between renal dysfunction and endocrine functions leading to a hypometabolic state is known. However, there is a lack of data regarding early treatment for subclinical hypothyroidism (SCH). When serum creatinine is elevated in SCH, it demands the need for investigation to assess if the elevated serum creatinine is due to true renal impairment and reduced glomerular filtration rate (GFR). For this, the estimated glomerular filtration rate (eGFR) helps in understanding the pathogenesis of renal involvement. Aims and objectives: The aim of the current study is to assess renal parameters, such as serum creatinine, urea, and uric acid levels in hypothyroid and SCH cases, and compare them with euthyroid patients. Materials and methods: A cross-sectional descriptive study was conducted from August 2019 to January 2020 at a tertiary care center in Bengaluru. A total of 90 hypothyroid female cases (including clinical hypothyroid and subclinical) were enrolled, along with age-matched 100 healthy controls. The Erba EM 360, a fully automated analyzer, was used to estimate serum creatinine, urea, and uric acid. Free triiodothyronine (fT3), free thyroxine (fT4), and thyroid-stimulating hormone (TSH) were analyzed using the Maglumi 800 chemiluminescent immunoassay (CLIA). The modification of diet in renal disease (MDRD) study equation and the chronic kidney disease-epidemiology collaboration (CKD-EPI) equation were utilized for the eGFR calculation. Results were presented as mean ± standard deviation (SD). The unpaired Student's t-test was applied to assess the association between cases and controls. Analysis of variance (ANOVA) was used to compare SCH and overt hypothyroid cases with controls. A p-value of <0.05 was considered statistically significant. Pearson's correlation coefficient was applied to evaluate the correlation between study groups. Result: Both MDRD eGFR and CKD-EPI were decreased in cases compared to controls, with a p-value of <0.01. There were three groups: SCH—group II (n = 50), clinical hypothyroidism (CH)—group III (n = 40), and controls—group I. Statistically significant differences were observed with eGFR calculated by MDRD and CKD-EPI between SCH, CH, and control groups (p < 0.01). TSH showed a moderate negative correlation with eGFR calculated by MDRD and CKD-EPI, with correlation coefficients of −0.43 (p < 0.01) and −0.47 (p < 0.001), respectively. Conclusion: Kidney function, compromised in thyroid dysfunction, can be early assessed with eGFR. Early diagnosis of kidney damage helps determine the at-risk population and enables timely management and prevention of associated future complications.

Aims and background: Chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) are significant contributors to type II respiratory failure, often necessitating interventions like noninvasive ventilation (NIV). This audit aimed to evaluate the utility of NIV following the British Thoracic Society (BTS) guidelines in managing acute exacerbation of chronic obstructive pulmonary disease (AECOPD) and OSA patients with type II respiratory failure. Methods: A total of 67 adult patients were recruited and assessed using vital parameters, arterial blood gas (ABG) reports, and clinical examinations. NIV was initiated based on BTS guidelines, and patients were monitored for response and tolerability. Data collection included demographics, comorbidities, NIV settings, and outcomes. Results: Among the patients, 92.5% had AECOPD, and 7.5% had OSA with type II respiratory failure. Initial NIV settings (12/6) resulted in improvement in blood gas parameters and clinical status for 75% of patients, while others required increased settings (14/7). Seven patients failed NIV and required mechanical ventilation, while 60 patients showed significant improvement over 24 hours. Conclusion: NIV, as per BTS guidelines, has demonstrated efficacy in managing AECOPD and OSA patients with type II respiratory failure. Clinical improvement and optimal blood gas parameters were observed in a majority of cases, highlighting the importance of NIV as an initial choice before invasive ventilation. Clinical significance: The study underscores the importance of adhering to guidelines in NIV management for respiratory failure cases, leading to improved patient outcomes and reduced need for invasive ventilation. This approach can be particularly beneficial in resource-limited settings and may have implications for COVID-19 management as well.

Background: Basic airway management is a lifesaving skill that needs to be mastered by undergraduate medical students. Training of procedural skills in the skills labs is found to be effective. Various skills teaching methods like Halstead's (see one, do one), Peyton's 4-step (student-to-teacher ratio of 1:1), and modified Peyton—for small group teaching with varying student-to-teacher ratios ranging from 3:1 to 13:1 were reported in literature, with few studies showing Peyton method to be more effective than standard teaching. Whereas, few other studies show only minor differences between Peyton's and Halstead's. Aim: This study was conducted to compare the effectiveness of modified Peyton's and Halstead's approaches in teaching basic airway management skills and to know about the students’ perception of modified Peyton's as a skills training method. Materials and methods: A study involving 60 undergraduate medical students was conducted in a skills lab using manikins, with a student-to-teacher ratio of 10:1. Overall, for skill 1 (airway maneuvers and use of airway adjuncts), group I (n = 30) students received training by modified Peyton's and group II (n = 30) students by Halstead's. For skill 2 (bag and mask ventilation), a crossover of groups was done. Group I (n = 30) received training from Halstead's, and group II (n = 30) from modified Peyton's. Students’ performance of both skills was assessed using an objective structured clinical examination (OSCE) 1 week after skills teaching. Students’ perceptions about modified Peyton's were obtained using a questionnaire on a 6-point Likert scale. Results: Objective structured clinical examination scores of skill 1 (Airway maneuvers and use of airway adjuncts) in group I (n = 30) were (17.63 ± 0.89) and in group II (n = 30) were (15.67 ± 1.42); (p < 0.001). OSCE scores of skill 2 (bag and mask ventilation) in group I (n = 30) were (15.10 ± 1.27) and in group II (n = 30) were (17.20 ± 0.96); (p < 0.001). Modified Peyton's was well accepted by students as a skills teaching method except for too many repeated observations of the procedure. Conclusion: Modified Peyton's was found to be an effective skills teaching method than Halstead's for teaching basic airway management skills. However, OSCE should be conducted at different time intervals, in order to assess the long-term retention of skills and to assess the transferability of learned skills to the bedside.

Background: Cancer not only affects the individual diagnosed but casts ripple effects on their caregivers too. The role of caregiver is multifaceted and requires continuous commitment to the well-being of patients. The burden of witnessing a loved one's suffering, stress of medical intricacies, disrupted routines, financial worries, and social isolation may lead to psychological distress in caregivers and adversely affect their quality of life (QoL). Materials and methods: Study was conducted on 100 caregivers of 100 patients who were diagnosed with advanced cancer. Psychological distress in patients and caregivers was assessed using Hospital Anxiety and Depression Scale (HADS) and effect of psychological distress on QoL was evaluated using the World Health Organization Quality of Life-BREF (WHOQOL-BREF) criteria. Data was collected and analyzed using Statistical Package for the Social Sciences (SPSS) statistical software version 20.0 at level of significance, p < 0.05. Results: The mean anxiety score was 10.75 ± 2.55 in the patients’ group and 11.79 ± 2.67 in the caregivers’ group, while the mean depression score was 11.62 ± 2.83 in the patients’ group and 10.86 ± 2.45 in the caregivers’ group. QoL for both patients and caregivers was assessed, revealing a mean physical health score of 48.87 ± 10.97 in the patients’ group and 57.71 ± 9.62 in the caregivers’ group. The mean psychological score was 46.26 ± 11.12 in the patients’ group and 47.77 ± 10.38 in the caregivers’ group. In terms of social relationships, the mean score was 32.32 ± 11.21 in the patients’ group and 43.15 ± 12.25 in the caregivers’ group. Lastly, the mean environment score was 50.65 ± 9.89 in the patients’ group and 53.44 ± 11.39 in the caregivers’ group. Conclusion: Along with cancer patients, their caregivers equally suffer from psychological distress. Caregivers of cancer patients have poor QoL which needs to be addressed.

Aim: To validate the cutoffs for percentage of weight loss associated with the risk of hypernatremia, taking into account other risk factors. Materials and methods: A total of 50 healthy neonates with a gestational age of ≥35 weeks in the postnatal ward were included. Their weight was checked daily until the 5th day of life using the same scale. Two groups were formed: one with newborns given exclusive direct breastfeeding until the usual cutoff for dehydration (10%), and another with newborns on direct breastfeeding with a cutoff considered at 7%. When the cutoff was exceeded, routine neonatal screening was performed, including monitoring sodium levels. Results: There were 50 cases of hypernatremia. For hypernatremic infants, the mean percentage of weight loss was 6–8%. Associated variables included greater weight loss, male sex, lower education level, primigravida, and cesarean delivery. Conclusion: Screening for early hypernatremia should consider multiple risk factors in addition to the percentage of weight loss.

Objective: Synovial sarcoma (SS) is a rare mesenchymal neoplasm that can occur in various sites with a morphological spectrum, and it has the ability to mimic other malignant neoplasms. Materials and methods: For this study, 15 cases of SS reported over a period of 5 years were analyzed. Results: The most common site of occurrence was the thorax. Monophasic histology was common in 60% of the cases taken for this study. The differential diagnosis varied depending upon the site and histology. The common aspects shared by all the cases of SS were variable immunohistochemistry (IHC) marker expression of epithelial membrane antigen (EMA), cytokeratin, S100, cluster of differentiation 99 (CD99), B-cell leukemia/lymphoma 2 protein (Bcl-2), and transducin-like enhancer of split-1 (TLE1), and being consistently negative for CD34. Conclusion: This study highlights the importance of knowledge as well as awareness about various histomorphological spectrums of SS in different sites.

Background and aims: There is an existing gap in medical undergraduate curriculum in the field of antimicrobial resistance (AMR) and antimicrobial stewardship (AMS). We designed and implemented a 2-week training program on AMR and AMS for 3rd-year medical undergraduates as part of elective postings under the new “competency-based undergraduate curriculum for the Indian medical graduate.” Materials and methods: The “elective posting on AMR and AMS” was conducted in two separate 2-week blocks/sessions involving a total of 30 students. The training comprised blended teaching-learning methods and included four different educational modules (1 week each), namely AMR; antimicrobial prescribing; AMS; and antibiotic allergy, antimicrobial surveillance, and community awareness. Results: Posttraining, there was a consistent increase in the number of correct responses to all knowledge-based questions pertaining to the four modules. A significant improvement in knowledge scores for all modules from baseline was also seen. The students rated the overall quality of training as very good and suggested the incorporation of such training in the routine undergraduate curriculum. All the faculty also agreed on the importance of such training at the undergraduate level and the suitability of content of modules. Conclusion: Medical students should be the target of teaching on principles and practices of antimicrobial prescribing and stewardship. An early start among future prescribers should provide a foundation for appreciating the importance of AMS and adoption of rational antibiotic prescribing practices.

Background: The cytopathological examination of effusion fluids is an essential aspect of everyday cytopathology practice. A standard, uniform reporting system across laboratories promotes good interobserver agreement and supports proper clinical care through the use of a set of diagnostic criteria. Materials and methods: The present study included all the cases of serous effusion fluids received over a 3-year period. The study was started after obtaining Institutional Ethics Committee clearance. The International System for Reporting Serous Fluid Cytopathology (ISRSFC) system was used, which classifies into five different categories—nondiagnostic (ND), negative for malignancy (NFM), atypia of unknown significance (AUS), suspicious for malignancy (SFM), and malignant (MAL). Results: A total of 600 serous effusion samples were included in the study, of which 337 were peritoneal fluid, 261 were pleural fluid, and two were pericardial fluid. The majority of the cases belonged to NFM (511; 85.1%), followed by MAL (47; 7.8%), ND (24; 4%), AUS (10; 1.6%), and SFM (8; 1.3%). The risk of malignancy (ROM) for category three was 75%, and that of categories four and five was 100%. Conclusion: The ISRSFC categories provide a user-friendly and accurate standard for the interpretation and reporting of effusion cytology.

Background and objectives: Laparoscopic procedures have the advantage of early recovery, but the majority of patients will experience moderate to severe pain, requiring effective pain relief during the postoperative period. Paracetamol is an important component of a multimodal analgesic treatment plan. Preemptive intravenous (IV) ketorolac produces significant opioid-sparing effects following laparoscopic surgeries. There is a lack of studies comparing the effects of preemptive IV ketorolac and IV paracetamol on postoperative pain. This study was conducted to compare the efficacy and safety of the preemptive use of IV paracetamol and IV ketorolac for the management of postoperative pain after laparoscopic surgeries under general anesthesia. Materials and methods: After ethics committee approval, a prospective double-blinded randomized controlled study was conducted among patients aged 18–60 years scheduled for elective laparoscopic surgeries under general anesthesia. A total of 54 patients were enrolled and divided into two groups (K and P), each comprising 27 patients. Patients in group K received IV ketorolac, while those in group P received IV paracetamol as postoperative analgesia. Results: Intraoperative—group K had significantly higher heart rates (HRs) at 30 and 60 minutes compared to group P. The p-values calculated at 15, 45, 75, 90, 105, 120, 135, and 150 minutes were found to be 0.5907, 0.1267, 0.7242, 0.5611, 0.3187, 0.4356, 0.0922, and 0.1640, respectively, and were not statistically significant. Group P exhibited significantly higher systolic blood pressure (SBP) at 60, 90, and 105 minutes compared to group K. Postoperative—patients in group K had slightly higher SBP at 30, 45, 60, and 120 minutes compared to those in group P. Visual analog scale (VAS) scores and the usage of rescue drugs (tramadol) were higher in group P. The time to first rescue analgesic usage was longer in group K compared to group P. Conclusion: Ketorolac serves as a better analgesic compared to paracetamol when used for postoperative analgesia in patients undergoing laparoscopic surgeries under general anesthesia.

Objective: The coronavirus disease 2019 (COVID-19) pandemic has resulted in many alterations in the management of surgical patients. We share our experience with surgical emergencies during the COVID-19 pandemic and their subsequent 3-year follow-up. Materials and methods: This observational study was conducted over 1 year. Demographic details, diagnosis, surgery, COVID-19 test results, inflammatory markers, days of hospital stay, and complications were collated from inpatient files, discharge summaries, and outpatient records. The follow-up data were collected by reviewing outpatient cards and conducting telephonic interviews. Results: A total of 70 children underwent emergency procedures. The age ranged from 0 to 17 years, and 60% were males. COVID-19 testing was done as per the institution's protocol. Around 27.1% were COVID-19 positive and underwent laparotomy, peritoneal dialysis catheter insertion, ventriculoperitoneal shunt revision, and central line insertions. Bowel gangrene secondary to vascular thrombosis in one child and burst abdomen following pyloromyotomy in another child were unique pathologies that could be attributable to COVID-19. The average hospital stay was 10.1 ± 5.5 days. The remaining 51 children underwent mostly laparotomy, endoscopy, and bronchoscopy. Conclusion: Surgical pathology dictates outcome in COVID-19-positive children. Vascular thrombosis-induced complications may be of concern but are amenable to timely intervention. Routine screening and following universal protocols ensure collateral protection. The use of prophylactic antibiotics and anticoagulants in COVID-19-positive surgical children needs validation in larger cohorts.

Background: Fine needle aspiration cytology (FNAC) is a well-established, cost-effective, simple, outpatient department (OPD) procedure for the investigation of thyroid swellings. As the thyroid is a highly vascular organ, a large amount of blood gets aspirated, which obscures cell morphology. To improve the quality of hemorrhagic thyroid FNAC smears, a new technique is used and compared with the conventional method. Aim: To evaluate the effect of Turk's fluid, which lyses the red blood cells (RBCs) in hemorrhagic thyroid aspirates, and compare it with conventional May-Grunwald Giemsa (MGG)-stained hemorrhagic thyroid aspirate smears. Materials and methods: The present study was a prospective observational study conducted in the Department of Pathology, RajaRajeshwari Medical College, Bengaluru, for a period of 1 year (August 2022–August 2023). Forty-four cases were included in the study. After the thyroid FNA procedure, five smears were made from the aspirated material, out of which one smear was immediately treated with Turk's fluid for 45–60 seconds and stained by MGG stain to produce Turk's fluid treated Giemsa smear (TTG). Two smears were stained by conventional MGG, and the remaining two smears were stained by hematoxylin and eosin (H&E). The MGG smears were compared with the TTG smears and evaluated. Results: The background retention of RBCs significantly reduced in TTG smears when compared to MGG smears, which was statistically significant (p-value <0.01). The cytoplasmic details and the nuclear details of the thyroid follicular cells were better seen in TTG smears when compared to MGG smears and were statistically significant (p-value <0.001). In this study, the duration of Turk's fluid treatment was validated up to 45–60 seconds for better hemolysis, following which the nuclear and cytoplasmic details were better appreciated. Conclusion: This study evaluates the benefits of easily available Turk's fluid as a potent hemolyzing agent that can be used in all hemorrhagic thyroid aspiration smears, thereby avoiding repeat FNACs.

Introduction: The coronavirus disease (COVID) pandemic has presented worldwide as multiple waves of infection. India has witnessed three waves of coronavirus disease 2019 (COVID-19). In this study, we have evaluated and compared the waves of the COVID-19 pandemic presented in North India. Objective: To compare the demography, clinical profile, and outcomes of COVID-infected patients during the first, second, and third waves of the COVID-19 pandemic. Materials and methods: Retrospective collection of demographic details, epidemiology, clinical presentations, outcomes, and follow-up reverse transcription polymerase chain reaction (RT-PCR) results of COVID-19-positive patients were correlated. Results: Retrospective analysis of data showed that positivity in COVID waves was higher during the second wave (10%), followed by the third wave (4.66%), and the first wave (2.95%). The history of the number of household contacts was comparatively higher during the second wave. Atypical presentations and mortality were also notably higher during the second wave (24.69%) than the first wave (14.7%) and third wave (8.6%). Conclusion: Emerging COVID variants due to mutation will lead to multiple waves until it becomes endemic.

The major pathophysiology of polycystic ovary syndrome (PCOS) is insulin resistance (IR). The association between lipid ratios and IR may vary with respect to ethnicity, and some of the indices are not relevant to predict IR in certain populations. A cross-sectional prospective observational study was carried out among PCOS subjects in the Department of Gynecology and Obstetrics and the Department of Biochemistry in a tertiary care teaching hospital located in South India to evaluate the association between triglyceride to high-density lipoprotein cholesterol (TG/HDL-C) and total cholesterol to high-density lipoprotein cholesterol (TC/HDL-C) with IR [as measured by homeostasis model assessment for insulin resistance (HOMA-IR), quantitative insulin sensitivity check index (QUICKI), and fasting glucose to insulin ratio (FGIR)]. The study evaluated 100 PCOS patients according to Rotterdam criteria by both clinical and laboratory tests, following the inclusion and exclusion criteria. Fasting insulin level was measured using enzyme-linked immunosorbent assay (ELISA) technique, and conventional lipid profile was estimated in Vitros dry chemistry analyzer. From the lipid profile values, lipid ratios such as TG/HDL-C and TC/HDL-C were derived. In the present study, TG/HDL-C and TC/HDL-C values showed significant differences among insulin-resistant (IR) and insulin-sensitive (IS) groups, confirmed by the HOMA-IR, FG-IR, and QUICKI values. Although the IR group showed no dyslipidemia, TG/HDL-C and TC/HDL-C ratios were significantly higher in the subjects with a HOMA-IR value of ≥2.63 (HOMA-IR positive) compared to those with a HOMA-IR value of <2.63 (HOMA-IR-negative). Therefore, an elevation in these ratios is a strong preliminary predictor of IR and its associated complications, which are more common in PCOS women including reproductive disorders and metabolic abnormalities [glucose intolerance, type 2 diabetes mellitus (T2DM), dyslipidemia, inflammation, oxidative stress, and cardiovascular disease (CVD)].

Introduction: The epidemic of substance abuse (SA), which was previously common in Western populations, is now prevalent in India and is increasing, particularly among adolescents. Changing cultural values, increasing economic stress, and dwindling supportive bonds are leading to initiation into substance use. Random urine drug testing (UDT) is considered useful and is warranted for continued employment. Aim: To determine the pattern and extent of SA among patients and screen the suspect cases using UDT. Materials and methods: This was a prospective observational study. Subjects with a history of current substance use or suspected use for >10–30 days, seeking treatment for any medical reason related to substance use as diagnosed by the physician or psychiatrist, belonging to any age-group or gender, were included. The urine samples were collected and run on the multidrug cassettes to determine the results. Results: A total of 226 subjects were included, with 98.23% being male. The analysis for substance abuse was conducted using urine samples, and the results showed that the maximum number of subjects tested positive for cannabis/marijuana. The most frequent combination of substances abused was alcohol + tobacco + cannabis/marijuana (THC). Conclusion: According to the opinions presented in this study, the majority of patients who used THC and other psychoactive drugs were associated with stress, tiredness, and fatigue, which can impair judgment and coordination. There is a need for education, law enforcement, and frequent drug testing to regulate the supply of psychoactive chemicals. To increase acceptance and enhance results, it is crucial to incorporate policies and initiatives.

Background: Nasotracheal intubation is the most common method of airway management in head and neck surgery patients. This study was undertaken to compare the ease of intubation, trauma during intubation, and better access to the surgical field using different types of endotracheal tubes (ETT) for intubation using a nasopharyngeal airway (NPA) in patients undergoing head and neck surgeries. Materials and methods: A prospective study was conducted in the Department of Anesthesiology of a tertiary care hospital in Bengaluru. About 90 patients undergoing head and neck surgeries, selected by simple random sampling, were divided equally into three groups. The patients were subjected to routine investigations and studied for ease of intubation, bleeding, and surgeon's satisfaction. Results: The study groups were comparable with respect to demographic characteristics, American Society of Anesthesiologists (ASA) grade, side of the nostril, and size of the ETT chosen. The ease of insertion was higher in Ring Adair-Elwyn (RAE) tube cases when compared with flexometallic and polyvinyl chloride (PVC) tubes (p < 0.05). Bleeding was slightly higher in RAE and PVC groups than the flexometallic group (p < 0.05). There was no statistically significant difference in the vital parameters between the three groups. Complications including kinking were seen in the flexometallic tube group, and displacement, refixation, bronchospasm, and postoperative cough were seen in the RAE group when compared to the other two groups. The surgeon comfort zone and surgical area clearance were significantly higher in the flexometallic group and RAE group than the PVC tube group. Conclusion: The ease of insertion of the tube was significantly better in the RAE tube group than in the flexometallic and PVC tube groups. The rate of complications, including bleeding, was also higher in the RAE group.

Introduction: Functional endoscopic sinus surgery (FESS) under local anesthesia (LA) is performed as a day-care procedure as an alternative to general anesthesia (GA). Aim: This study assesses the outcomes of FESS performed under LA in two tertiary centers over a 15-year period by the main author. Materials and methods: A retrospective data collection was conducted. All adults who underwent FESS under LA for a 15-year period from 2008 to 2022 in the Department of ENT (ORL-HNS), Dr Kamakshi Memorial Hospital and Prashanth Super Speciality Hospital, Chennai, Tamil Nadu, India, were included in this study. Data and information on preoperative assessment, surgical indications, sinuses operated on, intraoperative findings, postoperative complications, and follow-up were recorded. Results: A total of 1,600 patients, among which 1,200 who met the inclusion criteria, were added to the study. The most common indications include chronic rhinosinusitis (CRS), nasal polyps, septal correction, turbinoplasty, dacryocystorhinostomy (DCR), and posterior nasal neurectomy. All paranasal sinuses were operated based on the pathology. In all cases, LA was used along with intravenous sedation. The majority of patients (90%) were discharged home the same day. Conclusion: Functional endoscopic sinus surgery under LA is a safe, cost-effective, and feasible alternative to GA and is well tolerated by patients. Complications of GA can be avoided.

The Philadelphia (Ph) chromosome is the hallmark of chronic myelogenous leukemia (CML). It is a shortened chromosome 22 resulting from a reciprocal translocation, t(9;22)(q34;q11), between the long arms of chromosomes 9 and 22. It is found in up to 95% of patients. However, 5–10% of patients with Ph-positive CML have variant translocations involving chromosomes other than 9 and 22. In this article, nine CML cases are being reported that carry variant Ph translocations involving both chromosomes 9 and 22, as well as chromosomes 2, 3, 8, 14, 16, and other various chromosomes, resulting in either a simple or complex karyotype.

Background: This study was conducted in the Department of Pathology, Silchar Medical College and Hospital, Silchar, Assam, India, from July 2017 to June 2018 to determine the prevalence of thrombocytopenia in highly active antiretroviral therapy (HAART)-naïve human immunodeficiency virus (HIV)-infected patients and correlate thrombocytopenia with cluster of differentiation 4 (CD4) count. Materials and methods: The study group comprised 99 HIV-infected adults presenting at the ART center/outpatient department/inpatient department (OPD/IPD) of the Department of Medicine who had not initiated HAART. Thrombocytopenia was defined as a platelet count <150,000/mm³ of blood. A brief workup included history, general and systemic examination, complete hematological workup, and bone marrow study in select cases. Patients under 16 years of age and those receiving HAART were excluded. Results: Thrombocytopenia was identified in 13 out of 99 patients in this study group, yielding a prevalence of 13.1%. Among these 13 patients with thrombocytopenia, 12 cases (92.3%) had a CD4 count <200, while only one case (7.7%) had a CD4 count ≥200. The association between thrombocytopenia and CD4 count was assessed using the contingency coefficient, yielding a value of 0.232 with a p-value of 0.018, indicating a significant association. Bone marrow studies were conducted in 10 cases, indicated by severe thrombocytopenia (platelet count <50,000 cells/mm²). Among these, three cases with severe thrombocytopenia on bone marrow examination showed an increased number of megakaryocytes with a normal granulocytic and erythrocytic series. These findings correlate well with previous studies. Conclusion: The prevalence of thrombocytopenia is 13.1% in the study population, and the association between thrombocytopenia and CD4 was found to be statistically significant. The contingency coefficient was evaluated with a value of 0.232 and a p-value of 0.018. This type of study is being reported for the first time from this part of our country.

Introduction: Septoplasty is a surgical correction of the deviated nasal septum. It is the most common ear, nose, and throat (ENT) surgery performed in adults. The main indication to perform septoplasty is nasal obstruction. The effectiveness of septoplasty remains uncertain, whether to address only the deviated septum or turbinate, or both. The objective of the current study is to evaluate the effectiveness of conventional septoplasty (with or without concurrent turbinate surgery) compared to resection septoplasty surgery for nasal obstruction in adults with a deviated nasal septum. Materials and methods: The study is designed as a comparative retrospective study of 100 cases: 50 cases of septoplasty for deviated nasal septum (2010–2013) and 50 cases of resection septoplasty for deviated nasal septum (2013–2016). A single surgeon operated on a total of 100 adults with nasal obstruction based on a deviated nasal septum. Conventional septoplasty was performed in one group and resection septoplasty in the other group. Follow-up visits will be scheduled at 0, 1, 3, 6, and 12 months. During each follow-up visit, a subjective visual analog scale (VAS) score will be performed. Conclusion: The resection septoplasty procedure involves a reduction in the volume of the turbinate with a straight, centrally placed septum. Minimal mucosal injury over the turbinate with electrocautery does not significantly interfere with the nasal mucociliary clearance mechanism. This technique has better postoperative improvement in addressing nasal symptoms and nasal cavity volume.

Introduction: Serum protein electrophoresis (SPEP) is a widely used biochemical test for diagnosing and monitoring plasma cell neoplasms, and it is frequently used in conjunction with immunofixation electrophoresis (IFE). Aims: To elaborate on the patterns of SPEP and IFE in a tertiary care hospital in eastern India. Materials and methods: A total of 455 cases satisfied the inclusion criteria of the study and were evaluated with SPEP using the Sebia Hydrasys 2 Scan Focusing System. IFE is performed when indicated. Results: Of the 455 cases, 153 (33.63%) had monoclonal gammopathy, with immunoglobulin G kappa (IgGκ) being the most prevalent monoclonal protein found (47.50%). Multiple myeloma was the most prevalent neoplasm involved in 280 (61.53%) cases. Conclusion: Serum protein electrophoresis and IFE are widely available and easy-to-administer tests recommended by international guidelines for screening and monitoring therapy of plasma cell neoplasms.

Background: Blood group status is essential for blood grouping, crossmatching, and medicolegal aspects. The ABO system and the Rhesus system (Rh) both influence blood group distribution. Blood coagulation tests, such as bleeding time (BT) and clotting time (CT), are crucial for surgery planning and assessing anticoagulant responses. BT is affected by platelet function, while CT is influenced by clotting factors. Objectives: To determine undergraduate students’ blood groups; to investigate the effect of the Rhesus factor on BT and CT. Methods: Institution-based cross-sectional observational study at Tripura Medical College and Dr BRAM Teaching Hospital. BT and CT assessed using Duke's method and capillary glass tube method, respectively. Blood groups determined based on agglutination presence or absence. Qualitative data expressed as percentages, quantitative data with mean and standard deviations. Analysis of variance (ANOVA) and Chi-squared tests used. Results: A total of 61 females (58%) and 44 males (42%) participated. Blood group B+ (31.4%) and O+ (30.5%) were the most predominant, followed by A+ (21.9%) and AB+ (9.5%). Differences in BT and CT across blood groups were observed but not significant. Conclusion: Blood group B+ and O+ were most common. Coagulation tests, BT and CT, varied across blood groups but were not significantly different.

Context: The peripheral blood neutrophil-to-lymphocyte ratio (NLR) has been studied as an inflammatory marker in many illnesses and solid tumors, but its usefulness as a biomarker of chronic obstructive pulmonary disease (COPD) exacerbation and its predictive value for COPD-related hospital admissions are still not established. Aims: The present study was designed to elucidate the levels of the NLR and eosinophil in smokers and nonsmokers male subjects with stable COPD. Settings and design: This prospective observational clinical study was conducted on 73 male stable COPD patients (35–60 years) from January to June 2023 after approval from the Institutional Ethics Committee. Complete blood counts (to calculate NLR and find the subjects with eosinophil higher or lower than 2%) and spirometry were performed. Statistical analysis: A point estimate and 95% confidence interval were estimated. Results: 61.65% were smokers (n = 45) and 38.35% were nonsmokers (n = 28). In smokers, 14 (31.11%) had moderate while 15 (33.33%) had severe COPD. In the nonsmoker group (n = 28), 13 (46.43%) had moderate while 11 (39.29%) had severe COPD. In smokers, 68.89% (31/45) had an NLR > 3; in nonsmokers, 57.14% (16/28) had an NLR < 3. Eosinophil counts >2% were found in 28 smokers (62.22%), whereas in nonsmokers, eosinophil counts >2% were found in 67.86% of subjects (19 out of 28 nonsmokers). Conclusion: The levels of eosinophils and NLR were higher in smokers as compared to nonsmokers with COPD. 68.89% and 62.22% of smokers with COPD had NLR >3 and eosinophil >2%, respectively. NLR and eosinophils are potential cost effective markers in COPD.

Background and aims: Understanding the factors determining parental decision-making may enable researchers to improve recruitment processes, optimize enrollment rates, and decrease disparities in pediatric research. The present study aimed to assess the factors associated with the parental decision to enroll their children in research, which can help inform future strategies to improve enrollment in pediatric research. Methods: A cross-sectional survey was conducted in high schools in two districts of Haryana (Rohtak and Jhajjar), India. Six hundred randomly selected children in grades 4–8 were given survey questionnaires and informed consent forms to be brought home and filled out by a parent or guardian. Data entry and descriptive presentation were done in Microsoft Excel. Associations between parental characteristics and potential willingness were assessed by logistic regression analysis using IBM Statistical Package for the Social Sciences (SPSS). Results: Three hundred eighty-four forms were included in the analysis. Age [odds ratio: 1.045; 95% confidence interval (CI): 1.002, 1.089; p = 0.039] and residence in rural areas (1.763; 1.063, 2.924; p = 0.028) were the most significant predictors of willingness. Study-related invasive procedures and concerns about the safety and efficacy of new treatments had a negative impact on parental consent, while studies conducted by a child's doctor or a government hospital favorably influenced parental decision-making. Conclusion: Our study provides an inferential point of view regarding parental willingness to enroll children in research as a function of parental age, socioeconomic factors, study investigators, site, and risk perception. Future work should aim to shed light on the extent of willingness and certainty of parents in allowing their children's participation in different kinds of research.

Aims and background: Tuberculosis is an important infectious disease of human beings from time immemorial. The conventional Ziehl–Neelsen (ZN) method for acid-fast bacilli (AFB) is an economical method for the diagnosis of tuberculosis. Fluorescent microscopy using Auramine O stain plays an important role in the detection of Mycobacterium because it is less time-consuming and lower magnifications can be used to examine smears. Our study aims to detect the accuracy of these techniques on various cytology samples received. Materials and methods: A total of 50 cytology samples collected from suspected cases of tuberculosis were included in the study. All samples were stained with both ZN stain and Auramine O stain and examined under a light microscope and fluorescent microscope respectively. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of both staining techniques were calculated and compared with the standard cartridge-based nucleic acid amplification test (CBNAAT) report. Results: Out of the total 50 samples, 35 (70.0%), 10 (20.0%), 4 (8.0%), and 1 (2.0%), are bronchoalveolar lavage (BAL) fluid, lymph node aspirates, pleural, and ascitic fluid respectively, of which, 39 (78%) were positive and 11 (22%) were negative by CBNAAT. In comparison with CBNAAT, the percentage of true positives was greater for the Auramine O stain than ZN stain (94.87 vs 74.4%). The PPV, NPV, and smear positivity of the Auramine O stain were higher compared to the ZN stain (97.4 vs 93.5, 83.3 vs 47.4, and 76 vs 62%, respectively). Conclusion: Auramine O staining with fluorescent microscopy has better accuracy compared to ZN staining with light microscopy for the diagnosis of tuberculosis in cytology specimens. Hence, fluorescent staining may be considered a superior investigation considering the importance of the early diagnosis and treatment of tuberculosis. Clinical significance: Auramine O staining with fluorescent microscopy can be utilized as a better routine investigation method for the diagnosis of tuberculosis bacilli in cytology samples.

Background: Insulin resistance is a common factor in nonalcoholic fatty liver disease (NAFLD). The study compares the clinicodemographic and metabolic features of NAFLD among obese and nonobese patients and analyzes predictive scores for better prediction and prognosis. Materials and methods: A prospective observational study was conducted in 180 NAFLD patients. Obese and nonobese patients with NAFLD were compared for clinicodemographic and metabolic features. Disease severity was assessed by homeostatic model assessment of insulin resistance (HOMA-IR), body mass index (BMI), age, and the presence of diabetes (BARD), aspartate aminotransferase (AST) to platelet ratio index (APRI), and fibrosis-4 (FIB-4) scores and analyzed statistically by multivariate regression analysis. Results: Mean age ranged between 42.31 and 46.65 years. Of the 180 NAFLD patients, 69.44% were obese (BMI >25), 14.44% were lean, and 16.11% were overweight; the rest were nonobese patients. Patients with a BMI <22.9 were grouped as lean, and those with a BMI between 23 to 25 were categorized as overweight. In metabolic profile no significant change was observed among obese and non-obese between obese and nonobese patients. In the severity assessment, HOMA-IR and NAFLD fibrosis scores were significantly higher in obese patients than in lean patients of the nonobese group. Multivariate regression analysis of HOMA-IR, BARD, NAFLD fibrosis, and controlled attenuation parameter (CAP) scores suggested a linear regression equation with predictors HOMA-IR, BARD, CAP, and BMI. The specificity and sensitivity of HOMA-IR and BARD scores were 0.67. Conclusion: Nonobese (lean and overweight) and obese patients have a common set of metabolic profiles except for BMI, impaired glucose tolerance, and insulin resistance. For severity assessment, HOMA-IR and NAFLD fibrosis scores can be comparable among nonobese (lean and overweight) and obese patients, and for ultrasonography (USG), CAP can be considered a suitable marker for both obese and lean patients.

Hemodialysis therapy is the core of treatment for patients with chronic kidney disease (CKD). The degree of compliance to the therapy, diet, and fluid restrictions determines the quality of life of hemodialysis patients. The present study aims to determine the therapeutic compliance and functional capacity of patients undergoing hemodialysis. Objective: The objective of this study is to determine the therapeutic compliance and functional capacity of patients undergoing hemodialysis. Methodology: A cross-sectional descriptive research was conducted among 50 hemodialysis patients at a selected tertiary care center, Chennai. After obtaining the setting permission and informed consent from participants, data was collected using pretested and validated tools such as background variables proforma of adults such as gender, religion, marital status, occupation, monthly income, educational status, type of family and health insurance, and clinical variables of adults such as height, weight, BMI, BP, potassium, urea, creatinine. Functional independence measure for the assessment of functional capacity, and rating scale for the assessment of therapeutic compliance. Data was collected by a self-administration method using the questionnaire method. The main data collection was done after determining feasibility and practicability by a pilot study. The data was tabulated and analyzed by using descriptive and inferential statistics. Results: The study reveals that the mean scores for each component of the therapeutic compliance regarding hemodialysis among hemodialysis patients such as potassium restrictions (4.11 ± 0.994), phosphorus restrictions (3.72 ± 1.17), fluid restrictions (3.78 ± 1.055), attendance in dialysis session (4.12 ± 0.93) with the overall mean scores of therapeutic compliance on hemodialysis as 11.18 ± 4.07. Conclusion: The study aims to determine the relationship between functional capacity and therapeutic regimen compliance in patients undergoing hemodialysis.

Introduction: Inflammatory markers are increased among children with febrile seizure (FS); whereas the efficacy of the combination of C-reactive protein (CRP) and neutrophil-to-lymphocyte ratio (NLR) among children with FS is not known. The aim of this study is to estimate and determine the correlation between CRP, NLR, and C-reactive protein and neutrophil-to-lymphocyte ratio (C-NLR) among case and control groups, and to determine the better predictor of inflammatory marker among children with FS. Materials and methods: A cross-sectional study was conducted in the pediatric department of a tertiary care hospital, Mandya Institute of Medical Sciences, Mandya, for 2 months. During the study period, 160 children aged between 6 months and 5 years were included, 80 children with FS were considered as cases and the remaining 80 children who had febrile illness without seizures were controlled. Descriptive statistics, independent t-test, and Pearson correlation were used. Receiver operating characteristic (ROC) analysis was used to compare NLR, CRP, and C-NLR and to predict their value among children with FS. Results: The mean value of CRP (1.58 ± 2.27) values was significantly higher among controls as compared to cases (3.46 ± 6.06) with a p-value of < 0.001. A positive correlation was found between CRP and C-NLR (0.719). In ROC curve analysis, it was observed that the area under the curve (AUC) for NLR (0.713) was higher as compared to CRP and C-NLR. Conclusion: NLR was comparatively higher among children with FS as compared to the control group and NLR has emerged as a better inflammatory marker among children with FS.

Background/objective: Rhinoliths are calcified masses that surround a nucleus. Every age-group experiences them. An endogenous or external core is possible. Nasal mucus, blood clots, and epithelium can all contain endogenous ones. In childhood, exogenous ones are created by calcification surrounding forgotten foreign bodies. Symptoms include unilateral headache, nasal blockage, or foul-smelling nasal discharge that persists despite medical therapy. Materials and methods: A prospective study of 11 patients (7 males, 4 females) diagnosed with rhinolith over a period of 8 years in a medical college hospital. Patient history, presenting symptoms, and thorough clinical examination and radiological investigation were done. Results: A total of 11 patients (7 males, 4 females) with mean age of 33.27 years. Among these six had deviated nasal septum (DNS) toward right and all six had rhinolith in right nasal cavity. Five had DNS toward left and all five had rhinolith in left nasal cavity. All 11 patients underwent endoscopic removal of rhinolith with septoplasty under general anesthesia. Conclusion: Rhinoliths are not a very uncommon condition. Formation of eddy currents behind the deviated part of the septum and collection of nasal secretions behind it causes precipitation of debris around forgotten foreign bodies leading to the formation of rhinolith.

Background: Rise in intraocular pressure (IOP) is a major risk factor for the development of primary open-angle glaucoma, and even in normal tension glaucoma, the reduction of IOP may slow the progression of visual field loss. The longer the IOP stays elevated, the more the vision is affected. The main objective of this study is to observe relationship between visual acuity and IOP in suspected glaucomatous patients and to find any association of age and gender with the visual acuity. Materials and methods: This observational study was conducted on 100 suspected glaucomatous patients. Visual acuity was recorded using Snellen's chart and IOP using GAT noncontact tonometry. Chi-squared test and Fisher's exact test, one-way analysis of variance (ANOVA) were applied using Statistical Package for the Social Sciences (SPSS-22). Statistical significance was assessed on 5% level of significance. Results: In the study, we observed 200 eyes of 100 patients, and it was found that 43 eyes had mild, 96 eyes had moderate, and 17 eyes had severe visual impairment. Visual impairment was found to be significantly associated with age, gender, and IOP. For right eye, the mean IOP showed a significant increase from 15.37 ± 2.91 mm Hg in normal to 23.13 ± 8.04 mm Hg in severe visual impairment. While for left eye, the mean IOP was increased from 16.42 ± 2.94 mm Hg among normal eyes to 17.08 ± 5.16 mm Hg among the severe visual impairment eyes. Conclusion: Present study showed a statistically significant relationship between IOP and vision, that is, as IOP rises there was increase in severity of visual impairment from normal to severe. Hence, controlling IOP is important to prevent visual impairment.

Aims and background: Traumatic brain injury (TBI) presents complex challenges in clinical settings, with outcomes varying widely based on injury severity. The Madras Head Injury Prognostic Scale (MHIPS) is an indigenously developed tool designed specifically for head injuries, integrating key parameters such as Glasgow Coma Scale (GCS) scores and computed tomography (CT) scan findings whereas Revised Trauma Score (RTS) is the standard scale used to assess prognosis in trauma patients worldwide. This study aims to compare the prognostic accuracy of the MHIPS and the RTS in predicting outcomes among patients with head injuries. The specific objectives include assessing the correlation between MHIPS and Glasgow Outcome Scale (GOS) scores, evaluating the predictive value of MHIPS for mortality, and comparing these findings with those obtained using RTS. Materials and methods: A longitudinal study was conducted on 100 patients admitted between December 2010 and January 2012 in a rural tertiary care center. MHIPS and RTS scores were assessed upon admission, and actual outcomes were measured using GOS after following up with the patients for 1 month post-admission. Correlation and regression analyses were conducted to evaluate the relationship between prognostic scales and actual patient outcomes. Results: Analysis revealed a strong positive correlation between RTS and GOS scores (r = 0.751, p < 0.001) but a stronger correlation between MHIPS and GOS scores (r = 0.890, p < 0.001). Regression analysis demonstrated MHIPS as a better predictor of GOS (β = 0.788, p < 0.001) and mortality (Exp(B) = 2.821, p = 0.006) compared to RTS. Conclusion: This study underscores the effectiveness of MHIPS as a reliable tool for prognosticating outcomes in TBI patients. MHIPS showed strong correlations with GOS scores and proved to be a better predictor of mortality compared to RTS. Clinical significance: These findings highlight the importance of integrating MHIPS into clinical practice to enhance the management and prognosis assessment of head injury cases, particularly in settings where precise prognostication is crucial for guiding treatment decisions and improving patient outcomes. It can help in the early identification of high-risk patients, leading to tailored interventions and improved management of TBI cases.

Background: Hysterectomy, a common surgical procedure for various gynecological conditions, significantly impacts women's health. This study aims to analyze the histopathological findings in hysterectomy specimens, correlating clinical indications with pathological outcomes, to enhance understanding, and improve patient management. Materials and methods: This retrospective observational study was conducted over 1 year (January 2023 to December 2023) at a tertiary care center. All hysterectomy specimens, irrespective of the surgical route or type, were included. Specimens were fixed in 10% formalin, processed, and stained using hematoxylin and eosin. Histopathological findings of the uterus, cervix, and ovaries were recorded and correlated with clinical diagnoses. Data were analyzed using Statistical Package for the Social Sciences (SPSS) version 29.0. Results: A total of 374 hysterectomies were performed: 70% abdominal, 26% vaginal, and 3% minimally invasive. Most patients (34.75%) were aged 41–50 years. Abnormal uterine bleeding (22.99%) and uterovaginal prolapse (20.85%) were the most common clinical indications. Histopathological examination revealed the proliferative phase of the endometrium (40.10%), leiomyomas in the myometrium (24.06%), and chronic cervicitis (23.52%) as the predominant findings. Gynecological malignancies accounted for 28.87% of cases, with ovarian cancer (13.36%) being the most frequent. Conclusion: Hysterectomy specimens commonly exhibit benign conditions such as proliferative endometrium, leiomyomas, and chronic cervicitis. Histopathological examination is crucial for confirming clinical diagnoses and guiding effective disease management. Clinical significance: This study underscores the importance of routine histopathological evaluation of hysterectomy specimens to ensure accurate diagnosis and optimal patient care. The findings highlight prevalent gynecological conditions, aiding clinicians in making informed decisions regarding hysterectomy indications and management.

Aim and background: Suicide remains a critical public health concern worldwide, with attempted suicidal behavior representing a significant risk factor for completed suicide. Numerous factors contribute to suicidal behavior; the role of metacognition, the ability to think about one's own thinking processes, has gained increasing attention in recent years. In this study, metacognitive patterns between individuals who have attempted suicide and those who are healthy controls in the context of depression are compared. Materials and methods: A case–control study was conducted on 30 suicide attempters and 30 healthy controls. Data was collected through a semistructured questionnaire that incorporated sociodemographic profiling. Depression was assessed by the Hamilton Depression Rating Scale, 24 items (HAMD-24). The Metacognition Questionnaire-30 (MCQ-30) was used to assess their metacognition, and the data was analyzed using the Statistical Package for Social Sciences (SPSS) version 23. Results: The study group scored significantly more than the control group in HAMD (23.47 ± 4.63 vs 8.27 ± 6.74). In the metacognition total scores, the study group (71.6 ± 14.89) had a significantly higher score compared to controls. Lack of cognitive confidence and positive beliefs and worry showed no significant differences (p = 0.172, p = 0.369). However, statistically significant differences were observed in negative beliefs about uncontrollability and danger (p = 0.005) and the need to control thoughts (p < 0.001). Age-groups above 29 years exhibited significant differences in metacognition, negative beliefs, and the need to control thoughts (p = 0.003, p < 0.001, and p = 0.001). When it came to gender, for males, lack of confidence (p = 0.027) and for females, negative beliefs (p = 0.049) and the need to control thoughts (p = 0.001) were significantly greater in the study group. Conclusion: There were significant differences in metacognitive beliefs and processes among these groups, underscoring the importance of considering metacognition in understanding suicidal behavior within the context of depression and developing targeted interventions to mitigate the same.

Background: India is primarily an agricultural country, with around 60–70% of its population dwelling on agriculture. The organophosphate (OP) class of pesticides is widely used throughout the world. However, they contain certain endocrine-disrupting chemicals (EDCs) that may lead to an increase in cancers and abnormalities in reproductive structure and function. The endocrine disruption by OPs has also been reported in the disruption of thyroid homeostasis. Materials and methods: It is a cross-sectional study conducted among farmers and agricultural laborers who have been using OP-containing pesticides for >6 months. Fasting blood (serum) samples were collected from the participants. The measurement of serum levels of thyroid hormones, which include free T3 (triiodothyronine), free T4 (thyroxine), and TSH (thyroid-stimulating hormone), and statistical analysis were carried out. Results: A total of 66 participants aged between 23 and 75 years were included and among them, 38 were female (57.6%). 26 participants have 10–20 years of exposure to OP compounds. The serum values of T3, T4, and TSH are within normal limits and no statistical significance was observed between the groups. Conclusion: The study concludes that indirect occupational exposure does not stimulate an effect strong enough to cause a drastic change and has a minimal effect on thyroid levels when measured in the nonsowing season. Further studies involving age and gender-matched controls with geographical concern are essential to investigate the change in thyroid levels with respect to the control samples.

Introduction: The estimated failure rate of anterior cruciate ligament reconstruction (ACLR) was 10–25% with retear rates of anterior cruciate ligament (ACL) grafts as high as 18% in young, high-demand populations. Besides the described causes of graft failure, there exists persistent rotational instability after ACLR in high-risk individuals, which might cause graft failure in the future. Lemaire introduced the concept of lateral extra-articular tenodesis (LEAT) as an adjuvant to routine ACLR, which can avoid rotatory stresses on the graft and prevent graft failures. This study aims to evaluate the efficacy of LEAT in preventing the failure of ACL reconstruction in high-risk patients. Materials and methods: Among 30 patients included in this study, 20 (66.6%) were males and 10 (33.3%) were females. The indications for LEAT were young, high-demand sports activity in 6 (20%) cases, hyperextension of the knee >10° in 12 (40%) cases, chronic ACL injuries (>3 months) in 8 (26.66%) cases, and revision ACLR in 4 (13.33%) patients. ACL tear-associated meniscal injuries were seen in 6 (20%) patients, for whom meniscal repair or balancing was done. Results: All the patients returned to their normal preinjury level, with a Tegner Lysholm knee function score of 94.73 ± 3.79 (excellent) at a mean follow-up of 3 ± 0.2 years. Three of them had reinjury to the same limb after 3 years of ACLR + LEAT. Arthroscopy performed in those cases revealed intact ACL grafts and minor meniscal injuries were repaired. Conclusion: LEAT combined with ACLR in high-risk patients can effectively reduce rotatory instability of the knee and avoid graft failures.

Aim and background: Depression is a heterogeneous disorder, and recent research evidence has identified links between depression and levels of three metabolites, namely vitamin B₁₂, folic acid, and homocysteine. Research has consistently highlighted that when nutrient supplementation is given along with antidepressants, it has a better response compared to antidepressant monotherapy. In this study, we examined the impact of supplementation of vitamin B₁₂ and folic acid on treatment outcomes of persons with depression when compared to subjects without supplementation. Materials and methods: The study included 56 subjects diagnosed with depression using the 10th Revision of the International Classification of Diseases and Related Health Problems (ICD-10), and its severity was assessed using the Hamilton Depression Rating Scale (HAM-D). Out of 56 subjects, one group (n = 28) was treated with the antidepressant tab escitalopram 10 mg alone, and the other group (n = 28) was supplemented with vitamin B₁₂ (1500 µg/day) and folic acid (5 mg/day) along with the tab escitalopram 10 mg for 3 months and reassessed. Results: There is a statistically significant reduction of HAM-D score in persons with depression and improvement in the severity of depression with respect to nutrient supplementation of vitamin B₁₂ and folic acid (p ≤ 0.05) compared to those without supplementation. It is also shown that there is a significant difference in postsupplementation subjects with respect to levels of vitamin B₁₂ and folate with p < 0.05 compared to presupplementation subjects. Conclusion: Vitamin B₁₂ and folic acid supplementation, along with antidepressant escitalopram, not only significantly improved treatment outcomes in depression, but their serum levels can also be used as biomarkers to assess the severity of depression. Clinical significance: Supplementation can be used as adjunctive therapy alongside conventional treatments such as medication and psychotherapy. Incorporating supplementation into treatment plans can empower patients to take an active role in managing their depression. A combination of vitamin B₁₂ (1500 µg/day) and folic acid supplementation with tab escitalopram represents a promising approach to improving treatment outcomes in depression. Additionally, their serum levels can serve as valuable biomarkers for assessing depression severity and guiding clinical decision-making, ultimately enhancing the quality of care for individuals living with depression.

Neuroleptic malignant syndrome (NMS) is a life-threatening condition occurring rarely when patients are exposed to neuroleptic drugs in clinical practice. It can occur in both genders with similar frequency. It is manifested by autonomic dysfunction, muscle rigidity, blood pressure fluctuation, fever, altered mental status, electrolyte imbalance, and organ dysfunction in the form of renal failure. Presentation can vary from mild to severe conditions in which multiorgan dysfunction can occur. Even permanent neurological damage can persist. Early detection and treatment may prevent complications in these patients with NMS. Always one needs to be highly suspicious when a patient is on neuroleptic drugs and develops any of the symptoms suspicious of NMS. We have presented a case series of three patients, presenting in three different clinical scenarios, who had developed NMS. NMS symptoms were detected earlier in all the cases and were treated successfully. This systematic review along with the case series will definitely enhance the knowledge regarding this rare but important clinical condition among emergency care physicians and improve the outcome of patients presenting with this condition. Objective: Increase the knowledge of NMS among critical care physicians to aid in early diagnosis and prevention of complications. Additionally, review various approaches to treating this condition. Materials and methods: We are sharing our clinical experience with NMS. This critical entity is extensively reviewed in this systematic review article, along with three important clinical cases presenting with NMS, to extend knowledge regarding this important entity to emergency care clinicians. More than 100 case series, case reports, and review articles in the available literature were studied while writing this systematic review.

Due to its complex etiology and influence on visual function, nystagmus is a complex oculomotor illness that poses a considerable challenge to clinicians and researchers alike. Nystagmus is characterized by involuntary rhythmic eye movements. An extensive summary of the several types of nystagmus, both acquired and congenital, will be given in this article. By providing a thorough analysis of nystagmus, this review helps researchers, doctors, and other healthcare professionals gain a deeper knowledge of the condition and work together to address its complex oculomotor disorders.

Anisocoria is a medical condition where the pupils of the eyes are unequal in size. It stems from diverse causes such as neurological issues, eye injuries, medication side effects, or underlying medical conditions. Depending on the underlying cause, anisocoria can be benign or indicative of a serious health concern. Diagnosis typically involves a thorough examination of the eyes and may necessitate further neurological evaluation. Treatment strategies vary based on the specific cause and may involve addressing the underlying issue or managing symptoms to improve the condition.

Aims and background: A great saphenous vein (GSV) is a significant superficial vein of the lower limb, frequently utilized for various medical procedures including venous access, vascular surgeries, and grafting. This systematic review aims to comprehensively analyze the research articles on anatomical variations of the human GSV, including its course, termination, size, and relationship with surrounding structures. The primary outcome of this review was the anatomical variation of the GSV at different regions of the lower limb. Materials and methods: The search was conducted through November 2023, utilizing the electronic databases PubMed, Cochrane Library, ScienceDirect, Google Scholar, SciELO, and manual searches of reference lists for articles published between 2005 and 2023. The number of articles reviewed was 10. Results: Most of the studies were performed by venous ultrasound (41.96%) and computed tomography venography (39.43%), while other studies used dissection (9.5%). One study was conducted postmortem (4.2%), and another utilized histological examination (2.04%). Conclusion: Most commonly, the GSV is located medially, and true duplication of the GSV was identified as an infrequent occurrence in only 1% of cases. Complications with the saphenous veins, as well as other leg veins, can give rise to an array of distressing symptoms. Clinical significance: The review will also explore the clinical significance of these variations, such as their impact on surgical procedures, ultrasound-guided interventions, and clinical assessments. Phlebography remains an indispensable tool for detecting and diagnosing complex venous conditions.

Introduction and aims: This review addresses antimicrobial resistance's human health impact and directs future research, adhering to the PRISMA (preferred reporting items for systematic reviews and meta-analyses) guidelines. Materials and methods: Using Scopus and PubMed, studies from 2018 to 2024 were screened, prioritizing original research, reviews, and meta-analyses. Exclusions comprised non-English papers, pre-2018 studies, and nonhuman subjects, resulting in 57 relevant papers. Results: Key contributors to antibiotic resistance include healthcare and agricultural overuse, inadequate wastewater treatment, and dissemination through microplastics and migratory species. Rising resistant strains like methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococcus (VRE) pose significant risks to vulnerable populations. Although promising, detection methods like MALDI-TOF and CRISPR-Cas systems lack universal adoption. Conclusion: Urgent coordinated action is necessary, requiring universal antibiotic regulations, enhanced wastewater treatment, and the development of alternative therapies like bacteriophages. Improved detection methods and stringent clinical guidelines are essential for containment, emphasizing the need for innovative nonantibiotic treatments and robust prevention strategies.

Aim and background: Endobronchial tuberculosis (EBTB) is a tuberculous infection of the tracheobronchial tree with microbial and histopathological evidence. It is part of pulmonary tuberculosis (PTB) not commonly diagnosed because bronchoscopy is not routinely done in PTB. Chung and Lee classified EBTB into seven types. Case description: Case 1: An 18-year-old female presented with a left collar stud abscess and cough with expectoration for 1 month. On examination, left interscapular crepitations were heard. X-ray and CT-thorax showed lingular segment collapse–consolidation. Pus from the abscess Xpert MTB/RIF (Mycobacterium tuberculosis/Rifampicin) was detected. Fiberoptic bronchoscopy (FOB) was done, which showed total occlusion of superior lingular segment bronchus (tumorous EBTB). Xpert MTB/RIF detected MTB in bronchial lavage. Case 2: An 18-year-old boy presented with cough with expectoration, fever, dyspnea, and weight loss of about 6 kg. On examination, left interscapular monophonic wheeze was heard. X-ray and CT-thorax showed a lateral segment of left lower lobe collapse–consolidation. His sputum acid-fast bacilli (AFB) was negative; hence, FOB was done, which showed partial obstruction of lateral segment bronchus of the lower lobe (actively caseating EBTB). Case 3: A 27-year-old female complained of cough with expectoration for 2 weeks. Her sputum AFB was scanty and Xpert MTB/RIF detected. CT-thorax showed small ectatic changes in the lingular segment. Because of the disparity of CT-thorax and sputum results, FOB was done, which showed a sago-grain appearance of the lower part of the trachea (granular EBTB). Conclusion: High clinical suspicion is required to diagnose EBTB since routine bronchoscopy is not performed in PTB patients. Follow-up bronchoscopy may be required since these patients might develop bronchostenosis later. Clinical significance: In our case series, we have shown the clinical features, diagnosis and management of EBTB, which helps to suspect EBTB and perform bronchoscopy on such patients.

Aim and background: Nocardia infections pose a significant challenge in immunocompromised patients, including solid organ transplant recipients and those with liver diseases such as alcoholic liver disease. These infections can often be misdiagnosed or overlooked due to their resemblance to tuberculosis and other pulmonary pathogens. Understanding the clinical presentation, risk factors, diagnostic challenges, and treatment outcomes of Nocardia infections in these populations is crucial for improving patient care and outcomes. The aim of this case series is to highlight the incidental discovery of Nocardia infections in transplant patients and individuals with liver diseases, shedding light on their clinical presentations, diagnostic approaches, management strategies, and treatment outcomes. By elucidating the challenges associated with diagnosing and managing Nocardia infections in these high-risk populations, we aim to underscore the importance of early recognition and appropriate treatment to reduce morbidity and mortality. Furthermore, we aim to emphasize the need for improved diagnostic tools and therapeutic interventions tailored to the unique characteristics of these patients. Through this case report, we seek to contribute to the existing literature on Nocardia infections in immunocompromised hosts and provide insights for clinicians managing similar cases in their practice. Case description: We report two cases of incidental discovery of Nocardia infections—one in a 38-year-old male with acute-on-chronic liver failure and acute kidney injury, and another in a 40-year-old male postrenal transplant. Diagnosis was confirmed through modified acid-fast staining of respiratory samples, and treatment with empirical antibiotics followed by targeted therapy with cotrimoxazole resulted in contrasting outcomes. Despite aggressive management, the patient with liver disease succumbed to the infection, while the transplant recipient showed symptomatic improvement and was discharged. Conclusion: Growing transplant rates and new immunosuppressive therapies are increasing Nocardia infections, which are often diagnosed late. Improved diagnostic tools, especially molecular techniques like MALDI-TOF MS and gene sequencing, are needed for early identification to reduce mortality in immunocompromised patients. Clinical significance: The clinical significance of this manuscript lies in its illumination of the challenges associated with diagnosing and managing Nocardia infections in immunocompromised patients, specifically solid organ transplant recipients and individuals with liver diseases.

Myiasis, a pathological condition characterized by the infestation of viable mammalian tissues through the deposition of eggs or larvae by flies, predominantly of the Diptera order, has exhibited a preeminent prevalence within tropical regions. This phenomenon is notably concomitant with suboptimal personal hygiene practices and occasionally compounded by constraints in manual dexterity. We present a case report of a 48-year-old male of Indian origin who presented with was diagnosed and was under treatment for irritant contact dermatitis but to our surprise, on examination, myiasis infestation was revealed.

The sciatic nerve (SN) is the largest nerve in the human body. It is made-up of ventral rami from lumbar to sacral spinal nerves and ultimately bifurcates into the common fibular (peroneal) nerve (CFN) and the tibial nerve (TN), most frequently just proximal to the popliteal fossa. Together, these nerves provide motor innervation to the lower leg muscles as well as the majority of sensory innervation to the skin of the lower leg. Sciatica is the term used to describe pain caused by compression of the SN, and it classically presents nerve pain, numbness, tingling, and weakness in the affected extremities. This case report details a 92-year-old white female donor who was found to have a bilateral high bifurcation of her SNs that passed between two heads of the piriformis muscle (PM). Identification of this anatomical variation inspired the initiation of a longitudinal research project at the Uniformed Services University of the Health Sciences (USUHS), during which we will analyze 70 cadavers with the objective of describing and quantifying the prevalence of high bifurcation of the SN variations and the involvement of the PM. This and other similar variations of the SN bifurcations have clinical implications, including diagnosis and treatment of sciatica pain, popliteal nerve block administrations, and surgical planning, all of which will be discussed here.

Acute parotitis is a common clinical manifestation of various viral infections, metabolic and drug-related conditions. Parotitis is a relatively rare clinical manifestation of dengue fever. Mumps, parvovirus B19, Epstein–Barr virus, and coxsackievirus infections are the more common causative agents. We report a case of a 16-year-old kidney transplant recipient who presented with fever, chills, myalgia, and acute unilateral parotid swelling. He was detected to have dengue viremia in the saliva and blood. His course was complicated by parotid necrosis and was managed with antipyretics and antimicrobials with successful outcome. Parotitis is a rare manifestation of dengue fever. Parotitis along with leukopenia should arouse the suspicion of dengue infection, especially in endemic areas.

Background: Ebstein's anomaly is a rare congenital cardiac defect causing atrialization of the right ventricle (RV) and has a wide spectrum of clinical presentation depending on the severity of the lesion. Case description: A 28-year-old G2P1L1 female at 36 weeks of gestation was evaluated for acute febrile illness and diagnosed with H1N1 influenza. During the clinical examination, a pansystolic murmur was heard, prompting a cardiac evaluation. A two-dimensional (2D) echocardiogram was performed and suggested Ebstein's anomaly with atrialized RV, which had remained undiagnosed during both her pregnancies. She had a further uneventful pregnancy and an uncomplicated delivery by cesarean section of a healthy child. Conclusion: Ebstein's anomaly has varying presentations and may remain asymptomatic depending on the severity of the lesion. Outcomes in pregnancy are generally favorable. Clinical significance: A thorough cardiac evaluation is important in antenatal checkups for early detection of any cardiac anomaly and its appropriate management to reduce risk to both mother and fetus.

Pericecal herniation of bowel is a relatively rare presentation in itself. Sigmoid colon being a content of this herniation is an exceedingly rare occurrence, with only a few case reports published to date. A suspicion of gangrene, and hence the need for immediate surgical intervention, must be considered in rare presentations of a computed tomography (CT)-documented pericecal herniation of sigmoid colon. Laparoscopic and open interventions for pericecal herniation of the small bowel have been carried out and reported in the past. However, strangulation of the pericecally herniated sigmoid warranting a resection has not been reported to date, to the best of our knowledge. We present a case of a 60-year-old male presenting to us with acute abdomen in the emergency department.

Granulomatosis with polyangiitis (GPA) is a rare multisystem autoimmune disease of unknown etiology involving small to medium vessels. It is one of the antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis disorders. Its hallmark features include necrotizing granulomatous inflammation and pauci-immune vasculitis. GPA with aseptic abscess is an even more uncommon presentation. This is the case of a 56-year-old female who presented to our outpatient department (OPD) with cough, breathlessness, right-sided chest pain, multiple cutaneous abscesses, and ulcers in lower extremities. Radiology evaluation showed bilateral nodules and cavitary lesions. c-ANCA was found to be positive. Skin biopsy was consistent with features of vasculitis. She was diagnosed with GPA with aseptic abscess syndrome and treated effectively with rituximab. The combination of GPA with aseptic abscess is a rare clinical entity. The mainstay of treatment is anti-inflammatory drugs.

Hereditary multiple osteochondromas is a condition characterized by multiple osteochondromas throughout the body. Anesthetic management can be challenging because of the location, size, number, and proximity of neurovascular structures, and pain management. This is a case report of an 18-year-old girl with multiple hereditary exostoses who was scheduled for excision of T12 vertebral exostosis. This case adds to the medical literature by providing valuable insights into the management of a rare and challenging condition. It offers a detailed account of the surgical and anesthetic considerations and emphasizes the importance of a multidisciplinary approach for optimal patient outcomes.

Invasive mucinous adenocarcinoma (IMA) is a distinct subtype of lung adenocarcinoma characterized by the production of mucin and a relatively poor prognosis. We present a case of a 42-year-old female presented with an infected bulla in the right upper lobe, which later turned out to be IMA. The diagnosis can be challenging, particularly when presenting as an infected bulla, a rare and unusual manifestation. Bullae are air-filled spaces within the lung parenchyma that can become infected, mimicking infectious processes. This case underscores the importance of considering malignancy in patients with chronic pulmonary infections.

Aims and background: Urinary retention induced by antipsychotics is commonly observed with low-potency first-generation antipsychotics but is rarely seen with second-generation antipsychotics (SGAs). Aripiprazole, known for its lower incidence of adverse effects, is rarely associated with urinary retention. This case report highlights aripiprazole's potential impact on bladder function and the need for close monitoring after initiation. Case description: An 18-year-old student with moderate depression experienced no improvement on initial treatment with mirtazapine and escitalopram at maximum tolerable dose and adequate time. Following this, the diagnosis was changed to treatment-resistant depression. To enhance the treatment response, aripiprazole 5 mg was added to the medication regimen. Within 1 week, the patient's mood showed significant improvement. However, the patient developed urinary retention, which prompted further investigation. Comprehensive neurological and urological examinations were conducted to exclude any organic causes for the urinary retention. Bladder ultrasound revealed a postvoid residual volume of 250 mL, but the patient did not require catheterization. Consequently, switching to olanzapine 2.5 mg resolved the urinary retention, suggesting aripiprazole as the cause. Conclusion: The resolution of symptoms upon discontinuation of aripiprazole indicates that it likely caused urinary retention. This may be due to its anticholinergic effects, weak H1 receptor antagonism, and α-1-adrenergic receptor blockade. Clinical significance: Aripiprazole-induced urinary retention is a clinically significant adverse effect, although it is relatively uncommon. It highlights the need for careful monitoring of urinary function in patients prescribed aripiprazole, especially those with predisposing factors for urinary retention. Early detection and management are crucial to prevent complications such as bladder dysfunction and kidney damage. This case underscores the importance of considering medication side effects in the differential diagnosis and adjusting treatment plans accordingly to ensure patient safety and comfort.

Non-Langerhans cell histiocytoses comprise a heterogeneous group characterized by the proliferation of cells with macrophage features. Xanthogranuloma (XG) is the most typical clinical manifestation of this group and is normolipidemic. XG typically occurs in children, usually presenting as a single lesion, though it can manifest at any age. It is extremely rare for XG to occur in adults, where it typically presents as multiple lesions. Both juvenile and adult forms of XG have been linked to several blood dyscrasias, although the adult variant has a more isolated history. Adults are infrequently affected, and when they are, it nearly always presents as a solitary tumor. The diversity of forms of XG makes it a unique condition. We report the case of a middle-aged gentleman presenting with gradually enlarging multiple brown-to-yellowish cutaneous lumps on his arms and legs, without systemic manifestations. Histopathologic examination revealed yellowish lesions composed of sheets of foamy histiocytes and intervening collagen bundles, which were immunopositive for cluster of differentiation 68 (CD68), confirming the diagnosis of XG. Although adult XG is not considered a paraneoplastic phenomenon, it is frequently associated with hematological malignancies. The likelihood of extracutaneous involvement remains uncertain, and the pathophysiology of the disease is poorly understood. This case of multiple adult xanthogranuloma (MAXG) adds to the scant literature and highlights the need for further research into this rare condition.

Aim and background: The limb body wall complex (LBWC) is a complex fetal malformation syndrome that is sporadic, extremely rare, and difficult to manage. It is associated with severe abdominal wall, spinal, and limb malformations. It is distinguished by a wide range of severe body wall abnormalities. Because the majority of the affected fetuses die in the womb, the incidence at birth is 0.32 per 1,00,000 births. The scope of anomalies in LBWC also known as “body-stalk anomaly” is extremely broad. Case description: A 24-year-old woman came for her nuchal translucency (NT) scan in the 13th week of pregnancy. On ultrasonography, the fetus showed multiple anomalies and was diagnosed with LBWC. The diagnosis and outcomes were explained to the patient. The patient decided to end the pregnancy and underwent medical termination of pregnancy. Upon the expulsion of the fetus, the ultrasound findings of the LBWC were confirmed. Conclusion: Limb body wall complex is a rare fetal anomaly that has a fatal outcome. It is usually diagnosed during the second or third trimesters of pregnancy. An early diagnosis can help improve the patient's outcome. It should be suspected when prenatal ultrasound shows abdominal wall abnormalities linked to craniofacial deformity along with limb deficits. Clinical significance: Even though it is a rare fetal anomaly, LBWC needs to be differentiated from gastroschisis and omphalocele. As the latter anomalies have a better outcome. Sonographic characteristics of LBWC include thoraco and/or abdominoschisis, neural tube anomalies, severe scoliosis, positional deformities, and irregularity of fetal membranes.

Aim and background: Escitalopram, a commonly prescribed selective serotonin reuptake inhibitor (SSRI) for psychiatric disorders, rarely causes endocrine and reproductive adverse effects like galactorrhea. This case report highlights newer adverse effects of escitalopram that must be considered for early diagnosis and better management. Case description: We present a case of a 39-year-old woman with complaints of palpitations, sweating, and shivering. She also has excessive worry regarding her health and has undergone numerous health check-ups. She was diagnosed with hypochondriacal disorder (ICD-10) and started on 5 mg of tablet escitalopram. A few weeks later, the dose was increased to 15 mg for better improvement. She developed breast enlargement and pain along with galactorrhea with normal prolactin levels after initiating tablet escitalopram at a dosage of 15 mg within 2 months. She was cross-tapered with tablet amitriptyline after attempting a re-challenge test once. The symptoms resolved upon discontinuation of escitalopram and did not recur with tablet amitriptyline. Conclusion: A 2021 study highlighted three cases of galactorrhea linked to paroxetine and fluvoxamine, associated with increased serum prolactin levels normalized upon drug discontinuation, likely due to D2 blockade. Clinicians must be aware of galactorrhea risk with these SSRIs. Our study presented a unique case of escitalopram-induced bilateral galactorrhea with normal prolactin levels, resolving postwithdrawal. This contrasts with a similar case of a 43-year-old woman on 20 mg escitalopram for 6 months. The rapid onset within 2 months at a lower dose (15 mg) in our case suggests thyrotropin-releasing hormone (TRH) hyperresponsiveness may play a role. Clinical significance: The resolution of galactorrhea following the discontinuation of escitalopram suggests it as a possible side effect. This condition can be particularly distressing and socially challenging, especially for women with adult children, as it may lead to unwarranted suspicions. As healthcare providers, particularly in mental health, it is crucial to recognize this rare side effect of SSRIs. We must handle this issue with sensitivity, offering appropriate interventions to alleviate the psychological and social impacts on our patients.

Human immune deficiency virus (HIV) infection is a multisystem disease with a variety of clinical manifestations in the renal system. In the glomerulus, it causes HIV-associated nephropathy (HIVAN) and immune complex disease whereas in the vascular compartment, it most commonly causes thrombotic microangiopathy. Although rarer, amyloid A (AA) amyloidosis is another entity that can involve all the compartments of the kidney in HIV-infected patients. We are reporting a case of a 35-year-old male, a resident of Atrauli, a daily laborer by occupation with an active naive [HIV + HCV (hepatitis C virus)] infection admitted for the evaluation of nephrotic syndrome. He gave a history of inhalational recreational drug abuse but denied any intravenous (IV) drug abuse. Renal function tests (RFT) of the patient were found to be normal. Based on the history and relevant investigations, there is no evidence of any other chronic infectious or inflammatory disease. The patient has been started on direct-acting antiviral (DAA) therapy for HCV on antiretroviral therapy (ART) for the HIV infection. A renal biopsy has been performed which revealed pale eosinophilic deposition over the mesangial matrix in hematoxylin and eosin (H&E) stain with Congo red stain positive and apple green birefringence on polarised light. Immunohistochemistry (IHC) was positive for serum amyloid A (SAA) protein suggesting renal AA amyloidosis. Thus, a renal biopsy is mandatory to look for other etiologies, even though the incidence is rare.

Leptospirosis, a zoonotic disease caused by the spirochete Leptospira, presents a diagnostic challenge due to its varied clinical manifestations, often mimicking common febrile illnesses. The spectrum of presentation is enigmatic, encompassing common symptoms like fever, myalgia, headache, and conjunctival suffusion to atypical manifestations like disseminated intravascular coagulation, fulminant hepatitis, pulmonary hemorrhage, aseptic meningitis, and hypokalemic acute interstitial nephritis with urinary magnesium loss. This diversity in clinical presentation is due to an exaggerated nonspecific systemic immunoinflammatory response. Due to its so many varied presentations diagnosis becomes challenging and increases the risk of misdiagnosis and inappropriate treatment. Understanding the varied presentations and maintaining a high index of suspicion in endemic regions or after exposure to contaminated environments is crucial for accurate diagnosis and prompt intervention. This abstract highlights the challenges we encountered in our hospital during monsoon in recognizing and managing leptospirosis, emphasizing the importance of clinical vigilance and targeted diagnostic approaches in suspected cases and also unraveling the atypical presentation.

Hepatopulmonary syndrome (HPS) is a rare, yet significant, complication of chronic liver disease (CLD) characterized by the triad of liver disease, arterial hypoxemia, and intrapulmonary vascular dilatations (IPVDs). It commonly complicates CLD, leading to significant morbidity and impacting patient prognosis. This case report presents a 56-year-old female diagnosed with decompensated liver cirrhosis (DLC), who exhibited persistent oxygen requirement and orthodeoxia, eventually leading to the diagnosis of HPS.

Juvenile nasopharyngeal angiofibroma (JNA) is a benign vascular tumor that appears in the nasal cavity. Although nonmalignant, it can expand quickly and extensively, including the sinuses, the orbit, and the brain, making it very difficult to treat. JNA generally affects the pubescent population; once patients enter adulthood, the disease strangely begins to settle down. Surgery is the principal mode of treatment.

Bronchogenic carcinoma can present with a wide array of symptoms and imaging findings, often mimicking other pulmonary conditions. This case report describes a 66-year-old male fisherman who was initially diagnosed and treated for nonfibrotic hypersensitivity pneumonitis (HP) but was later found to have bronchogenic carcinoma. The overlapping clinical and radiological features between HP and bronchogenic carcinoma pose significant diagnostic challenges. Our case report highlights the importance of considering a comprehensive differential diagnosis, especially in patients with complex exposure histories and persistent symptoms. Recognizing the potential for malignancy in atypical presentations is essential for timely and appropriate management.

Background: Gallbladder (GB) diseases, either acute or chronic, can develop rare complications like the development of cholecystocutaneous and cholecystohepatic fistula. External fistula can occur through various means, including spontaneous, posttraumatic, or iatrogenic origins. Cholecystohepatic cutaneous fistula formation has not been reported in the literature. Therefore, the available information on this condition is limited. Case description: We are reporting a case of a gentleman in his 70s with a history of sealed GB perforation with perihepatic and anterior abdominal wall abscess, and incision and drainage (I&D) of the abscess done elsewhere. Thereafter, he presented to us with a bilioserous discharge from the I&D site. He also had a history of ERCP and stent placement for a CBD calculus. We performed a laparoscopic converted to open cholecystectomy with CBD exploration. Intraoperatively, methylene blue dye injected through the skin opening showed the dye coming through the inferior surface of the liver, and its presence in the GB confirmed the presence of cholecystohepatic cutaneous fistula. Conclusion: It is possible that the initial formation of a cholecystohepatic fistula occurred following the type II variant of GBP. Subsequently, the needle aspiration and I&D may have led to the formation of a type III cholecystohepatic cutaneous fistula. Despite its rarity, the possibility of a cholecystohepatic cutaneous fistula should be considered in patients presenting with a chronic draining fistula in a patient with a history of an invasive procedure like needle aspiration or I&D and unusual abdominal pain. The possibility of liver parenchyma involvement should not be missed to avoid future problems.