Background: Metabolic equivalents (METs) are used during exercise testing as an estimate of functional capacity. There are specifically designed questionnaires to find out MET and exercise capacity. The Duke Activity Status Index (DASI) is a self-administered questionnaire designed to assess physical function and predict exercise capacity. The Modified Chinese version Veterans Specific Activity Questionnaire (VSAQ) is a 13-item self-administered questionnaire that estimates functional capacity expressed in METs. Materials and methods: Two hundred and thirty participants were included in the study according to inclusion criteria and were made to answer DASI and Modified Chinese version VSAQ, and METs were calculated. Participants performed treadmill test, i.e., Bruce Protocol. All the vital parameters were assessed before and after the completion of the treadmill test and METs achieved at that stage were noted. Results: The limits of agreement between DASI, VSAQ, and Bruce Protocol were assessed using Bland–Altman method. Duke Activity Status Index and Bruce Protocol showed p – 0.001, CI – 95%, and Modified Chinese version of VSAQ and Bruce Protocol showed p – 0.001, CI – 95%. The mean of MET calculated by the Modified Chinese version of VSAQ was statistically close to the mean of MET calculated by Bruce Protocol MET. Conclusion: There is no agreement between DASI and the Modified Chinese version of VSAQ with Bruce Protocol in healthy individuals. The Modified Chinese version of VSAQ has closer MET values to Bruce Protocol. Hence, the Modified Chinese version of VSAQ may be considered for the assessment of functional capacity in the Indian population.

Background: Pain has a multifactorial origin; therefore, it may be difficult to achieve pain management with a single drug. Hence, multimodal analgesia was introduced. Multimodal analgesia is achieved by combining different analgesics that act by different mechanisms and at different sites in the nervous system, resulting in additive or synergistic analgesics with lowered adverse effects of sole administration of individual analgesics. This is advantageous as it acts by both peripheral and central pain pathways; this minimizes pain with better tolerability and reduces recovery time. The multimodal strategy allows early mobilization, early enteral nutrition, and attenuation of the perioperative stress response which leads to reduced morbidity and accelerated convalescence. Materials and methods: After institutional ethical committee approval, 60 patients undergoing abdominal surgeries and laparotomies belonging to the American Society of Anesthesiologists (ASA) I and II of either sex, aged between 20 years and 70 years were enrolled for this study. Thirty were provided unimodal analgesia with inj. tramadol and the other 30 received multimodal analgesia with quadratus lumborum block (QLB), inj. tramadol, and inj. diclofenac for postoperative analgesia. Our main aim was to assess the efficacy of multimodal analgesia vs unimodal analgesia for postoperative pain management. Results: We observed the visual analog scale (VAS) pain scores in patients of both groups at 0, 2, 4, 8, and 12 hours. When the scores were above 7, rescue analgesia with inj. fentanyl was provided. The duration of the first analgesic request and the total number of rescue analgesics given were recorded along with any complications. Conclusion: Multimodal analgesia was superior compared with the unimodal approach as it provided better analgesia with low VAS score values. Duration of analgesia was longer based on time of request of first rescue analgesia, with reduced adverse effects. It reduced the number of rescue analgesics required and the opioid side effects were overcome by non-steroidal anti-inflammatory drug (NSAID) use.

Background: Tubercular pyomyositis is a rare entity in immunocompetent induvial, and involvement of head and neck region is very uncommon. It usually presents as diffuse swelling with some tenderness and other constitutional symptoms of tuberculosis (like a low-grade fever, loss of appetite, and weight loss). It can also mimic other entities like a pyogenic abscess, malignancy (sarcoma), benign soft tissue tumors, cervical lymphadenitis, and hematoma; which can pose a diagnostic challenge. Case description: We here present a case of a 22-year-old male who came with complaints of neck swelling with low-grade fever and weight loss for about a month duration. A detailed clinical history and examination helped us to narrow down the differential. Finally radiological imaging and microbiological test aided in clenching the diagnosis and helping with further management. The patient was diagnosed with tubercular pyomyositis of cervical muscles and was successfully treated with first-line anti-tubercular therapy.

Undescended testis in children is a common condition in a daycare setting. It presents clinically either as palpable or non-palpable, although the former is more common. The two children whom we came across presented with non-palpable testis, were incidentally found to have unilateral hydronephrosis. In both the children, the testis was reported to be in the iliac fossa near the deep inguinal ring on ultrasound. However, the palpation of cord structure with a vaguely palpable flabby scrotal content prompted to do an open orchidopexy in both of them, citing a possibility of a nubbin. During gubernacular dissection, in one child, the vas was found looping beyond the superficial inguinal ring and when traced cranially led to the testis popping out from the deep ring. In the other child, the testis was found in the inguinal canal with vas looping distal to it. It is important at this point to bear in mind this variation to prevent accidentally transecting the vas while dividing the gubernaculum. Highlights: • Anomalies of vas in association with undescended testis are rare and are even rarer with an added hydronephrosis as an association. • This observation has not been reported in the literature so far.