Chirayu Medical College & Hospital

Leadership is as old as ancient culture. Nurses are anticipated to exercise leadership irrespective of their number of years of experience or position. This article discusses the traits of a leader as intelligence, determination, personal integrity, personality, excellent communication, self-confidence, thoughtful mentorship, and emotional intelligence; and briefs leadership theories. It is furthered with leadership skills required in nursing and nursing leadership competencies elaborated by various authors. Subsequently, it heads with the influence of leadership styles on nurses based on evidences. And it continues with attributes of a leader as narrated by researchers. This article is completed with the concept of self-leadership and how it assists in day-to-day nursing practice.

Introduction: Roux-en-Y hepaticojejunostomy is the standard procedure for restoring biliary-enteric continuity in benign biliary diseases, including choledochal cysts, post-cholecystectomy bile duct injuries, oriental cholangiohepatitis, and benign strictures. This retrospective study aimed to evaluate the long-term outcomes of Roux-en-Y hepaticojejunostomy performed for various benign biliary diseases, with particular emphasis on the incidence, timing, risk factors, and management of late complications, primarily anastomotic stricture and recurrent cholangitis.Materials and Methods: This single-center retrospective study analyzed 100 consecutive patients who underwent Roux-en-Y hepaticojejunostomy for benign biliary disease between January 2015 and March 2022. Data were retrieved from a prospectively maintained database with a minimum six-month follow-up. The median duration of follow-up was nine months (range: 6-15 months). Inclusion criteria included patients of any age with benign indications; exclusions included malignancy, major comorbidities, and referrals from other centers. Standard technique involved end-to-side anastomosis using 4-0/5-0 absorbable sutures, often via the Hepp-Couinaud approach. Statistical analysis was performed using the chi-square test.Results: The cohort comprised 100 patients, predominantly 66 (66%) female patients, and most commonly aged 31-40 years. The primary indication for Roux-en-Y hepaticojejunostomy was choledochal cysts in 52 (52%) patients, followed by bile duct injuries in 33 (33%) patients. Long-term complications included recurrent cholangitis in 39 (39%) patients and anastomotic stricture in 20 (20%) patients. Stricture rates were the highest among patients with bile duct injuries. There was no significant association between sex and stricture development (p = 0.58). A near-significant trend was observed between younger age (<40 years) and a higher stricture incidence (p = 0.063). Postoperative bile leakage (p = 0.021) and cholangitis (p < 0.001) were strong predictors of anastomotic stricture formation.Conclusion: Roux-en-Y hepaticojejunostomy for benign biliary diseases is associated with considerable late morbidity, particularly following bile duct injury. Postoperative bile leak and early cholangitis emerged as key modifiable predictors of anastomotic stricture. From a technical perspective, construction of a wide, tension-free mucosa-to-mucosa anastomosis at the hepatic hilum, preferably using the Hepp-Couinaud approach whenever feasible, is likely protective by ensuring optimal vascularity and reducing anastomotic narrowing. Younger patients may therefore require closer surveillance.

This study deals with how R&D spending and ESG SCORE work together to impact green innovation results in publicly traded Indian companies. It investigates what the strategic integration of environmental, social, and governance (ESG) practices with research and development (R&D) expenditure affects the production of green patents, using a panel dataset of 739 firm-year observations from 2019 to 2025. Research shows that ESG scores and R&D intensity both greatly improve the performance of green innovation. More significantly, the association between R&D expenditure and green innovation outcomes is positively moderated by ESG score, indicating that R&D activities have a higher influence on innovation for ESG-oriented organizations. By presenting ESG as a dynamic strategic facilitator as well as a compliance framework, this study adds to the growing body of research on sustainable innovation. The results have significant ramifications for business executives and legislators who want to encourage ethical innovation and sustained competitiveness in developing nations.

Ulcerative colitis, a chronic inflammatory bowel disease, renders the colonic mucosa particularly vulnerable to complications during endoscopic procedures. This case illustrates a serious complication following colonoscopy in active disease. A 25-year-old female presented with two weeks of hematochezia. Colonoscopy revealed severe active inflammation with ulcerations, friability, and spontaneous bleeding throughout the examined colon, consistent with chronic ulcerative colitis. Histopathology confirmed chronic architectural distortion with acute inflammatory infiltrates. Four hours post-procedure, the patient developed acute abdominal pain with guarding. Imaging demonstrated pneumoperitoneum with free subdiaphragmatic air. Emergency laparotomy identified a 4- to 5-mm perforation at the splenic flexure, correlating with an area of severe endoscopic inflammation. The site showed marked wall thinning without evidence of malignancy. Surgical management included primary closure with omental patch reinforcement and peritoneal lavage. This case demonstrates several key clinical considerations. First, it highlights the increased perforation risk during colonoscopy in active ulcerative colitis, particularly in severely inflamed segments. The splenic flexure's anatomical vulnerability may further predispose to perforation. Second, it emphasizes the importance of early recognition, where prompt surgical intervention likely contributed to the patient's successful recovery despite significant peritoneal contamination. Third, it illustrates the decision-making process for primary repair versus resection in iatrogenic perforations. The patient's postoperative course included appropriate antibiotic therapy and gradual nutritional advancement. At the time of discharge, she showed marked clinical improvement with resolving inflammatory markers. This case underscores the need for careful risk-benefit assessment when performing colonoscopy in active colitis and reinforces the value of preparedness for potential complications.

A limp is an abnormal, uneven or laboured gait typically resulting from pain, weakness, or structural deformity involving the hip, lower limb, spine or abdominopelvic abnormalities. Limps in children are common and have diverse causes that can be benign to life-threatening including trauma, congenital malformations, and neoplastic diseases. Diagnosis involves identifying gait abnormality thoroughly examining history and physical exam, assessing tenderness and range of motion, and completing targeted lab and radiographic studies. We present an imaging review of various usual and unusual causes of limp in different age groups such as in toddlers (1-3 years), children (4-10 years), and adolescents (11-16 years) with a comprehensive literature review.