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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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/mm³). 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.

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: 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: 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)].

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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 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.

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.

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.

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.

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.

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.